Extensor Carpi Radialis Longus Technique for Thumb Arthritis

LETTERS TO THE EDITOR Extensor Carpi Radialis Longus Technique for Thumb Arthritis To the Editor:

I read with interest the recent article titled “Trapeziectomy and Intermetacarpal Ligament Reconstruction with the Extensor Carpi Radialis Longus (ECRL) for Osteoarthritis of the Trapeziometacarpal Joint: Surgical Technique and Long-Term Results” by Illarramendi et al (J Hand Surg 2006;31A:1315– 1321). I have used a similar technique for almost 20 years. The technique described shows a different method of suspending the thumb metacarpal from the index metacarpal reconstructing the intermetacarpal ligament. I realize a comprehensive reference list can be a daunting task, but I did note that 2 articles I think pertinent to this particular technique were excluded. In the American Journal of Orthopaedics, we published a report describing the use of the extensor carpi radialis longus in what we termed a tendinoplasty and we described the local ligament anatomy.1 The technique was different regarding the use of the split ECRL and the tunnel for the intermetacarpal ligament reconstruction, for which our method used a transmetacarpal tunnel. Also, I would note the article by Livesey et al,2 which compares 2 techniques including the use of ECRL, also was omitted. I believe the multiplicity of treatment modalities for carpometacarpal joint arthritis shows that the underlying trapezium excision is probably the prime factor in patients’ clinical improvement, as noted by the author. Thumb index metacarpal stabilization, regardless of the tendon or method used, needs to be based on each individual clinical scenario.

In Reply:

Thank you for your letter dated December 8, 2006, in which I learned about Dr. Eglseder’s article that appeared in the American Journal of Orthopaedics in 2001, addressing a condition similar to the one described in our recent article “Trapeziectomy and Internal Ligament Reconstruction with the Extensor Carpi Radialis Longus for Osteoarthritis of the Trapeziometacarpal Joint: Surgical Technique and Long-Term Results.” I deeply regret not having read Dr. Eglseder’s article because I agree with him that it would have been pertinent to our article. Aldo A. Illarramendi, MD Ciudad Autónoma de Buenos Aires, Argentina doi:10.1016/j.jhsa.2007.02.014

In Reply:

Thank you for your interest in our work. As scientists, we seek naturalistic explanations for observed phenomena. We would like to point out that there exists overwhelming evidence from geology, paleontology, genetics, embryology, and comparative anatomy to support the position that organisms have evolved from predecessor organisms and that anatomic and physiologic adaptations are the result of natural selection. Although we respect your opinions, we do not believe that a scientific journal is the appropriate forum to debate nonscientific theories and divine perspectives. Scott W. Wolfe, MD Joseph J. Crisco III, PhD Caley M. Orr, MA Mary W. Marzke, PhD New York, NY doi:10.1016/j.jhsa.2007.02.011

W. Andrew Eglseder, MD Baltimore, MD doi:10.1016/j.jhsa.2007.02.013

References 1. King PJ, Eglseder WA Jr, House HO. Exterior carpi radialis longus tendinoplasty for thumb basil joint arthritis. Am J Orthop 2001;30:213–219. 2. Livesey JP, Norris SH, Page RE. First carpometacarpal joint arthritis. A comparison of two arthroplasty techniques. J Hand Surg 1996;21B:182–188.

The Dart-Throwing Motion of the Wrist. Is It Unique to Humans? To the Editor:

Wolfe et al (J Hand Surg 2006;31A:1429 –1437.) have submitted an interesting article regarding comparative anatomy among primates. Specifically as it relates to wrist kinematics. They observe that the The Journal of Hand Surgery

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