Capsuloplasty of the Dorsal Carpometacarpal Ligament Complex by Arthroscopy in Carpometacarpal Instability...

Carpometacarpal (CMC) joint instability can arise from multiple factors, including rheumatoid arthritis, congenital abnormalities, connective tissue disorders, and acute or cumulative trauma. Early detection is crucial, as ligamentous laxity leads to joint incongruence, which, if left untreated, may progress to osteoarthritis(45) First-line treatment consists of immobilization with a splint combined with physical therapy. However, when conservative management fails, surgical stabilization of the CMC-1 joint becomes necessary. Traditional open techniques typically require bone tunnels and tendon harvesting. Technique: We present a novel arthroscopic technique that is less invasive and reinforces the dorsal capsule and dorsal ligaments complex. This approach, inspired by the Birman open procedure, is based on the concept that the dorsal ligament complex is the primary stabilizer of the CMC-1 joint. Results: Seven cases were followed for an average of 24 months. The mean visual analog scale (VAS) pain score was 0. The Kapandji score was 10. Grip strength reached 95% and pinch strength 92.5% of the contralateral hand. One complication was observed: transient irritation of the dorsal radial nerve.

Arthroscopy is a viable option for capsuloplasty of the dorsal carpometacarpal ligament of the CMC-1 joint. It offers a minimally invasive alternative with fewer risks and less tissue damage while providing improved visualization of the joint, bone, and soft tissues and avoiding the need for complex joint reconstructions.