Related Experiment Videos
Partial arthroscopic trapeziectomy and stabilisation by ligamentoplasty: Outcomes in patients younger than 60years
Sharon Abihssira1, Pierre Desmoineaux1, Tiphanie Delcourt1
1Service de chirurgie orthopédique et traumatologique, centre hospitalier de Versailles, 78150 Le Chesnay, France.
Insights
Partial arthroscopic trapeziectomy with suspensionplasty effectively improved thumb carpometacarpal joint osteoarthritis outcomes in patients under 60. This minimally invasive technique offers sustained pain relief and strength restoration with low morbidity.
Area of Science:
- Orthopedic Surgery
- Hand Surgery
- Osteoarthritis Research
Background:
- Thumb carpometacarpal joint (TCMJ) osteoarthritis is a common reason for hand surgery referrals.
- Current surgical techniques have limitations, including risks of strength loss or implant complications, especially in younger patients.
- Partial arthroscopic trapeziectomy (PAT) with suspensionplasty using the abductor pollicis longus (APL) tendon is explored as an alternative.
Purpose of the Study:
- To evaluate the outcomes of PAT combined with APL tendon suspensionplasty in patients under 60 years old with TCMJ osteoarthritis.
- To assess improvements in pain, strength, range of motion, and patient-reported scores.
- To determine the medium-term efficacy and safety of this minimally invasive approach.
Main Methods:
- Retrospective study of consecutive patients under 60 with symptomatic TCMJ osteoarthritis (Stages 1-3) treated between 2007-2017.
- Data collected included pain intensity, grip and key-pinch strength, range of motion, Nelson Hospital Score (NHS), and Patient-Rated Wrist Evaluation (PRWE) score.
- Radiographic review was performed to assess joint changes.
Main Results:
- Significant improvements in pain intensity, grip strength, and key-pinch strength were observed (p<0.001).
- Mean follow-up was 64.7 months; mean NHS was 83.2 and mean PRWE was 15.4.
- Low morbidity was noted, with a mean sick leave of 5.4 weeks and only one patient requiring further surgery.
Conclusions:
- PAT with APL tendon suspensionplasty provides sustained medium-term improvements in strength and pain for younger patients with TCMJ osteoarthritis.
- The technique demonstrates a favorable risk profile, short recovery time, and low complication rates compared to other procedures.
- This minimally invasive approach is a viable option for younger patients, with potential for comparison against arthroplasty in future studies.
Background:
Thumb carpometacarpal joint (TCMJ) osteoarthritis is the fourth leading cause of referral to elective hand surgery. None of the available techniques has proved superior over the others. Some techniques carry unacceptable risks for younger patients, such as loss of strength and shortening of the thumb column after total trapeziectomy, or wear and loosening after total arthroplasty. Our objective was to assess outcomes after partial arthroscopic trapeziectomy (PAT) combined with suspensionplasty using the abductor pollicis longus (APL) tendon in patients younger than 60years of age.
Hypothesis:
PAT combined with suspensionplasty using the APL tendon in patients younger than 60years would restore strength in the medium-term without further surgery.
Material And Methods:
We retrospectively included consecutive patients operated between 2007 and 2017, in a single centre, and aged less than 60years. All patients had isolated TCMJ osteoarthritis stage 1 to 3 according to Eaton and Glickel classification that remained symptomatic despite optimal conservative treatment. We collected pain intensity, range of motion, strength, the Nelson Hospital Score (NHS), and the Patient-Rated Wrist Evaluation (PRWE) score. Radiographs were reviewed.
Results:
We included 27 patients, of whom 6 had surgery on both thumbs, yielding 33 thumbs for the analysis. Mean follow-up was 64.7months (range: 10.6-136.5months). Pain intensity, grip strength, and key-pinch strength were significantly improved (p<0.001), with no difference between men and women. No differences were found for the Kapandji score (p=0.2) or TCMJ hyperextension (p=0.06). At last follow-up, the mean NHS was 83.2±19.4 and the mean PRWE was 15.4±17.9. Mean sick leave duration was 5.4weeks (range: 1-24weeks). Only 2 patients, both in manual jobs, were unable to return to work. The radiographs at last follow-up showed the development of moderate TCMJ narrowing in 14 patients and evidence of scapho-trapezio-trapezoid (STT) osteoarthritis in 10 patients. No patient experienced complex regional pain syndrome or injury to the sensory branch of the radial nerve. A single patient required further surgery for persistent pain.
Discussion:
Patients younger than 60years who are treated with this minimally invasive technique are likely to experience sustained improvements in both strength and pain intensity. Total trapeziectomy and pyrocarbon implant has also been evaluated in younger patients, who experienced pain relief and strength gains but had lower levels of satisfaction and developed complications inherent in the implants. The short time off work and low morbidity make our technique a procedure of choice in younger patients. To build on this study, a comparison of PAT and arthroplasty would be of interest.
Level Of Evidence:
IV.