Clinical and Patient-Reported Outcomes After Ligament Reconstruction for Traumatic Thumb Carpometacarpal Instability

Area of Science:

• Orthopedic surgery
• Hand surgery
• Musculoskeletal research

Background:

• Chronic traumatic thumb carpometacarpal (CMC) instability presents a challenge due to potential cartilage damage impacting treatment effectiveness.
• Ligament reconstruction is a surgical option, but its efficacy in the presence of pre-existing trauma requires thorough evaluation.

Purpose of the Study:

• To assess patient- and clinician-reported outcomes following ligament reconstruction for chronic traumatic CMC instability.
• To identify factors influencing postoperative pain and functional scores.

Main Methods:

• A cohort of 43 patients with chronic traumatic CMC instability underwent various ligament reconstruction techniques.
• Outcomes including pain (Visual Analog Scale, Michigan Hand Outcome Questionnaire), function, strength, range of motion, and complications were tracked over a mean of 8 years.
• Statistical analysis, including linear mixed models, was employed to evaluate results and identify predictors of pain.

Main Results:

• Significant improvements were observed in Visual Analog Scale and Michigan Hand Outcome Questionnaire pain and function scores from baseline to 12 months and long-term follow-up.
• Thumb stability was preserved, range of motion maintained, and grip/pinch strength improved post-surgery.
• The dorsal ligament reconstruction technique was identified as a predictor of poorer postoperative pain scores; one patient developed osteoarthritis.

Conclusions:

• Ligament reconstruction is a viable and effective treatment for chronic traumatic CMC instability, yielding considerable improvements in patient-reported outcomes.
• The dorsal ligament reconstruction technique warrants careful consideration due to its association with less favorable pain outcomes.