FCR Interposition Arthroplasty for Concomitant STT and CMC Arthritis

Arthritis of scaphotrapeziotrapezoid joint is common and can be seen in association with first carpal metacarpal (CMC) arthritis. Untreated scaphotrapeziotrapezoid arthritis may be a cause of residual pain after CMC arthroplasty. There are various treatment options described in the literature ranging from arthrodesis, resection arthroplasty, interpositional arthroplasty, and implant arthroplasty. We describe a novel technique of flexor carpi radialis (FCR) tendon interposition to tackle this condition. Our common treatment for CMC arthritis is trapezium resection with ligament reconstruction and tendon interposition with half of the FCR. With this procedure, through the same exposure, the proximal part of the trapezoid is resected. An anchor is placed into the trapezoid and the sutures are passed through a remnant of the FCR. Thus the FCR is pulled in between the scaphoid and the trapezoid and secured in place. We performed this procedure in 13 hands with average follow-up of 36 months. All patients were satisfied with the procedure and were pain free at their last follow-up. The advantage of this procedure is the use of the FCR, which is already available in the field and requires very little additional procedure.