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Suspensionplasty With the Abductor Pollicis Longus Tendon for Osteoarthritis in the Carpometacarpal Joint of the Thumb
Suspensionplasty With the Abductor Pollicis Longus Tendon for Osteoarthritis in the Carpometacarpal Joint of the Thumb Osamu Soejima, MD, Tatsuo Hanamura, MD,† Tomomi Kikuta, MD, Hiroyuki Iida, MD, Masatoshi Naito, MD From the Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan; Ohita Orthopaedic Hospital, Ohita, Japan; and Iida Orthopaedic Clinic, Miyazaki, Japan.
Purpose: Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. This article reports our clinical and radiographic results in performing suspensionplasty using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for patients with painful osteoarthritis in the carpometacarpal joint of the thumb. Methods: Eighteen patients (2 men, 16 women), including 21 thumbs with advanced arthritis of the first carpometacarpal joint, who were treated by suspensionplasty using the APL tendon after a complete trapeziectomy were evaluated both clinically and radiographically. Ten thumbs were classified as stage III and 11 were classified as stage IV (Eaton’s classification). The average follow-up period was 33.3 months. Results: All patients (18 patients, 21 thumbs) reported pain with daily use before surgery; after surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. At the final follow-up evaluation the radial and palmar abductions each were 56° ⫾ 9° and 56° ⫾ 6°. The grip and key-pinch strengths were 16 ⫾ 6 kg and 4 ⫾ 1 kg, respectively. The first metacarpal subsidence at rest was 15% and the additional subsidence when performing a 2-kg key pinch was 6% in the final follow-up radiographic findings. Conclusions: This study showed that the APL suspensionplasty has a favorable outcome for painful osteoarthritis in the carpometacarpal joint of the thumb and that the APL tendon can be removed as a deforming force without any abduction weakness. (J Hand Surg 2006;31A: 425– 428. Copyright © 2006 by the American Society for Surgery of the Hand.) Type of study/level of evidence: Therapeutic, Level IV. Key words: Osteoarthritis, trapeziometacarpal joint, suspensionplasty, abductor pollicis longus tendon, trapeziectomy.
he goals of surgical treatment for painful osteoarthritis at the carpometacarpal joint of the thumb are the relief of pain and the restoration of stability and strength. Many surgical procedures have been described for treating these disabling conditions. Although ligament reconstruction and tendon interposition (LRTI) arthroplasty using the flexor carpi radialis tendon1 have been used widely, some reports have pointed out the occurrence of postoperative first metacarpal subsidence.2,3 Furthermore recent studies also have suggested that the addition of
T
†Deceased. .
tendon interposition did not affect the outcome after ligament reconstruction.4,5 Thompson6 first described the suspensionplasty procedure using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for cases of painful scaphometacarpal impingement after a trapeziectomy either without intercarpal ligament reconstruction or with the removal of silicone trapezium replacements. Diao7 also reported the biomechanical advantages of this procedure based on a cadaveric biomechanical analysis using a sonic digitizer tracking system. Belcher and Nicholl8 reported the surgical outcomes of a different technique using The Journal of Hand Surgery
425
426
The Journal of Hand Surgery / Vol. 31A No. 3 March 2006
the APL tendon as a sling. This article reports our clinical and radiographic results in performing suspensionplasty using the APL tendon in patients with painful osteoarthritis in the carpometacarpal joint of the thumb.
Patients and Methods Eighteen patients (2 men, 16 women) (21 thumbs) with a 1-year minimum follow-up period were included in this study. The average age at surgery was 63 years (range, 52–77 y). According to Eaton’s classification9 10 thumbs were classified as stage III and the other 11 were classified as stage IV. The pain, range of motion, and grip and key-pinch strengths were assessed before and after surgery. For the radiographic evaluations standard posteroanterior and oblique radiographs with the hand at rest were taken for all patients before surgery and at each follow-up visit. At the final follow-up examination standard oblique radiographs were taken of the site of the arthroplasty with the hand at rest and using a 2-kg key pinch. As an index of first metacarpal subsidence the ratio of the height of the trapezial resection space divided by the length of the first metacarpal was applied on the postoperative radiographs at rest and while performing a 2-kg key pinch (Fig. 1).3 The average follow-up period was 33 months (range, 12–71 mo). The range of motion and grip and keypinch strengths were expressed as the mean ⫾ SD. All data were subjected to statistical analysis using
Figure 1. As an index of first metacarpal subsidence the ratio of the height of the trapezial resection space (B) divided by the length of the first metacarpal (A) was applied on postoperative radiographs both at rest and when using a 2-kg key pinch. Reprinted with permission from Soejima.12
Figure 2. Suspensionplasty. After performing the trapeziectomy the APL tendon is passed through the thumb and the index metacarpal tunnels and then is sutured to the extensor carpi radialis brevis (ECRB) tendon using an interweave-type juncture. Reprinted with permission.12
the paired t test. A p value of less than .05 was considered significant. Surgical Technique According to the original procedure described by Thompson6 the thumb is exposed using a Wagner incision with meticulous attention to the sensory branch of the radial nerve. After the complete removal of the trapezium in a piecemeal fashion the entire width of the APL tendon is divided at its musculotendinous junction and then is flipped out to the first metacarpal insertion site. The first bone tunnel is made approximately 1 cm distal from the articular surface to the center of the first metacarpal base articular surface with a 3.2-mm– diameter cannulated drill. The second bone tunnel is made from the radiopalmar portion of the second metacarpal base (trapezial facet) to the ulnodorsal surface in the same manner. Subsequently the APL tendon is passed through the thumb and the index metacarpal tunnels (Fig. 2). The thumb metacarpal was positioned at the level of the index carpometacarpal joint when tensioning the APL tendon through the bone tunnels. Finally the free end of the APL tendon was sutured under manual tension to the extensor carpi radialis brevis tendon using an interweave-type juncture. Neither tendon interposition nor a temporary transfixing pin was applied in our series. A short-arm thumb spica splint was applied for 2 weeks and then range-of-motion and grip-strengthening exercises were initiated.
Soejima et al / APL Suspensionplasty
Results After surgery temporary paresthesia in the superficial radial nerve distribution was noted in 4 patients and metacarpophalangeal hyperextension remained in 2 thumbs. No patient required a revision surgery after this procedure. Subjective Outcomes Before surgery all patients (18 patients, 21 thumbs) reported pain when performing light daily activities; 7 patients (8 thumbs) complained of some pain even at rest. After surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. Sixteen patients believed that the reconstructed thumb was more effective for activities involving pinching and gripping than it had been before surgery, whereas the remaining 2 patients with metacarpophalangeal hyperextension noted some weakness when opening jars and using keys. No patient complained of any abduction weakness. Objective Outcomes The radial and palmar abductions improved from 42° ⫾ 24° to 56° ⫾ 9° (p ⫽ .094) and from 48° ⫾ 19° to 56° ⫾ 6° (p ⫽ .069), respectively. The grip and the key-pinch strengths also improved from 14 ⫾ 7 kg to 16 ⫾ 6 kg (p ⫽ .178) and from 2.7 ⫾ 1.8 kg to 4.0 ⫾ 1.2 kg (p ⫽ .225), respectively. The ratio of the height of the trapezial resection space divided by the length of the first metacarpal was decreased during the follow-up period from 0.20 to 0.17 (p ⫽ .004). This space, however, was preserved in the range of 0.17 to 0.16, even when performing the 2-kg key pinch (p ⫽ .045) in the final follow-up radiograph. The arthroplasty space was maintained in all patients and no patient showed any evidence of an impingement of the metacarpal against the scaphoid.
Discussion Thompson6 first described the suspensionplasty procedure using the APL tendon for cases of painful scaphometacarpal impingement after a trapeziectomy without either intercarpal ligament reconstruction or with the removal of silicone trapezium replacements. Recently Diao7 reported a cadaveric biomechanical analysis using a sonic digitizer tracking system to evaluate the efficacy of LRTI arthroplasty, Thompson’s suspensionplasty, and a modification of APL suspensionplasty in terms of maintaining thumb metacarpal position after a trapeziectomy. Based on his findings both Thompson’s suspensionplasty and the modified suspensionplasty had less proximal and dorsal migration than LRTI arthroplasty. As a result
427
this procedure therefore is considered to have some biomechanical advantages over standard procedures. Yang and Weiland3 observed a 21% subsidence of the first metacarpal at rest and an additional 11% subsidence during stress at a mean of 32 months after LRTI arthroplasties. Tomaino10 emphasized the importance of the temporary pin fixation of the thumb metacarpal to preserve the trapezial space, thereby restoring thumb strength. In our series neither tendon interposition nor a temporary transfixing pin was applied. The subsidence ratio decreased from 0.20 to 0.17 at rest; however, this ratio ranged from 0.17 to 0.16 even when performing a 2-kg key pinch at a mean of 33 months after surgery. As a result this suspensionplasty modality shows favorable stability of the thumb. Some investigators have found no correlation between the height of the arthroplasty space and the overall degree of patient satisfaction, pain relief, or improvement in the thumb function or strength.2,3,5,8,11 Belcher and Nicholl8 reported comparative results of trapeziectomy with and without LRTI using the APL tendon as a sling and concluded that the addition of a ligament reconstruction did not confer any additional benefit. In their 13-month follow-up series, however, marked scaphometacarpal abutment occurred in at least 2 of the total 42 thumbs after surgery in each group, and 1 patient in the LRTI group required revision surgery. Even if postoperative scaphometacarpal abutment after trapeziectomy did not cause any symptoms in a short period of follow-up evaluation this condition still may cause symptoms that may require revision surgery after long-term follow-up evaluation. The restoration of thumb stability should be essential at least in terms of preventing scaphometacarpal abutment after trapeziectomy. In this study metacarpophalangeal joint hyperextension remained in 2 thumbs without proximal first metacarpal subsidence after this procedure. These 2 patients with metacarpophalangeal joint hyperextension still felt some weakness when opening jars and using keys. Diao7 suggested that it would be better to perform capsulodesis of the metacarpophalangeal joint if a persistent hyperextension of greater than 30° was observed before surgery. One weakness of our study was the small number of patients and the short period of follow-up evaluation. Hence additional prospective randomized studies of larger numbers of patients with a longer follow-up period are needed. Thompson6 described the advantages of this procedure as follows: (1) technically it is easier to perform than some other procedures, (2) the APL tendon is removed as a deforming force, and (3) the flexor carpi radialis tendon is preserved as a wrist stabilizer. Diao7 also reported a modified technique of this procedure in
428
The Journal of Hand Surgery / Vol. 31A No. 3 March 2006
which the suspension point was established at a more distal point on the index metacarpal to obtain superior stability of the thumb. Another advantage of this procedure may be that the suspension point can be moved more distally at the surgeon’s discretion. The authors thank Edward Diao, MD, San Francisco, CA, for his constant interest and guidance throughout this study. Dr. Tatsuo Hanamura, the second coauthor of this article, suddenly passed away on August 20, 2005. The authors cordially dedicate this study to the memory of Dr. Hanamura, Ohita, Japan. Received for publication June 1, 2005; accepted in revised form December 1, 2005. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Corresponding author: Osamu Soejima, MD, PhD, Assistant Professor and Chief, Hand and Wrist Surgery Service, Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; e-mail: [email protected]. Copyright © 2006 by the American Society for Surgery of the Hand 0363-5023/06/31A03-0011$32.00/0 doi:10.1016/j.jhsa.2005.12.010
References 1. Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg 1986; 11A:324 –332. 2. Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg 1996;21A:202–209.
3. Yang SS, Weiland AJ. First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb. J Hand Surg 1998;23A: 879 – 883. 4. Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCormack RR. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop 1997;342:42– 45. 5. Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg 2004;86A:209 –218. 6. Thompson JS. Complications and salvage of trapeziometacarpal arthroplasties. Instr Course Lect 1989;38:3–13. 7. Diao E. Trapezio-metacarpal arthritis. Trapezium excision and ligament reconstruction not including the LRTI arthroplasty. Hand Clin 2001;17:223–236. 8. Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg 2000;25B:350 –356. 9. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg 1984;9A:692– 699. 10. Tomaino MM. Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis. Rationale, current technique, and clinical outcome. Hand Clin 2001;17:207–221. 11. Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg 2001;26A:862– 868. 12. Soejima O. [Suspensionplasty for osteoarthritis in the carpometacarpal joint of the thumb.] In: Takaoka K, ed. New NOW orthopaedic surgery. Vol. 22. Tokyo: Medical View, 2004:156 –160.
Purpose: Many surgical procedures have been described for treating painful osteoarthritis at the carpometacarpal joint of the thumb. This article reports our clinical and radiographic results in performing suspensionplasty using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for patients with painful osteoarthritis in the carpometacarpal joint of the thumb. Methods: Eighteen patients (2 men, 16 women), including 21 thumbs with advanced arthritis of the first carpometacarpal joint, who were treated by suspensionplasty using the APL tendon after a complete trapeziectomy were evaluated both clinically and radiographically. Ten thumbs were classified as stage III and 11 were classified as stage IV (Eaton’s classification). The average follow-up period was 33.3 months. Results: All patients (18 patients, 21 thumbs) reported pain with daily use before surgery; after surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. At the final follow-up evaluation the radial and palmar abductions each were 56° ⫾ 9° and 56° ⫾ 6°. The grip and key-pinch strengths were 16 ⫾ 6 kg and 4 ⫾ 1 kg, respectively. The first metacarpal subsidence at rest was 15% and the additional subsidence when performing a 2-kg key pinch was 6% in the final follow-up radiographic findings. Conclusions: This study showed that the APL suspensionplasty has a favorable outcome for painful osteoarthritis in the carpometacarpal joint of the thumb and that the APL tendon can be removed as a deforming force without any abduction weakness. (J Hand Surg 2006;31A: 425– 428. Copyright © 2006 by the American Society for Surgery of the Hand.) Type of study/level of evidence: Therapeutic, Level IV. Key words: Osteoarthritis, trapeziometacarpal joint, suspensionplasty, abductor pollicis longus tendon, trapeziectomy.
he goals of surgical treatment for painful osteoarthritis at the carpometacarpal joint of the thumb are the relief of pain and the restoration of stability and strength. Many surgical procedures have been described for treating these disabling conditions. Although ligament reconstruction and tendon interposition (LRTI) arthroplasty using the flexor carpi radialis tendon1 have been used widely, some reports have pointed out the occurrence of postoperative first metacarpal subsidence.2,3 Furthermore recent studies also have suggested that the addition of
T
†Deceased. .
tendon interposition did not affect the outcome after ligament reconstruction.4,5 Thompson6 first described the suspensionplasty procedure using the abductor pollicis longus (APL) tendon without tendon interposition after a complete trapeziectomy for cases of painful scaphometacarpal impingement after a trapeziectomy either without intercarpal ligament reconstruction or with the removal of silicone trapezium replacements. Diao7 also reported the biomechanical advantages of this procedure based on a cadaveric biomechanical analysis using a sonic digitizer tracking system. Belcher and Nicholl8 reported the surgical outcomes of a different technique using The Journal of Hand Surgery
425
426
The Journal of Hand Surgery / Vol. 31A No. 3 March 2006
the APL tendon as a sling. This article reports our clinical and radiographic results in performing suspensionplasty using the APL tendon in patients with painful osteoarthritis in the carpometacarpal joint of the thumb.
Patients and Methods Eighteen patients (2 men, 16 women) (21 thumbs) with a 1-year minimum follow-up period were included in this study. The average age at surgery was 63 years (range, 52–77 y). According to Eaton’s classification9 10 thumbs were classified as stage III and the other 11 were classified as stage IV. The pain, range of motion, and grip and key-pinch strengths were assessed before and after surgery. For the radiographic evaluations standard posteroanterior and oblique radiographs with the hand at rest were taken for all patients before surgery and at each follow-up visit. At the final follow-up examination standard oblique radiographs were taken of the site of the arthroplasty with the hand at rest and using a 2-kg key pinch. As an index of first metacarpal subsidence the ratio of the height of the trapezial resection space divided by the length of the first metacarpal was applied on the postoperative radiographs at rest and while performing a 2-kg key pinch (Fig. 1).3 The average follow-up period was 33 months (range, 12–71 mo). The range of motion and grip and keypinch strengths were expressed as the mean ⫾ SD. All data were subjected to statistical analysis using
Figure 1. As an index of first metacarpal subsidence the ratio of the height of the trapezial resection space (B) divided by the length of the first metacarpal (A) was applied on postoperative radiographs both at rest and when using a 2-kg key pinch. Reprinted with permission from Soejima.12
Figure 2. Suspensionplasty. After performing the trapeziectomy the APL tendon is passed through the thumb and the index metacarpal tunnels and then is sutured to the extensor carpi radialis brevis (ECRB) tendon using an interweave-type juncture. Reprinted with permission.12
the paired t test. A p value of less than .05 was considered significant. Surgical Technique According to the original procedure described by Thompson6 the thumb is exposed using a Wagner incision with meticulous attention to the sensory branch of the radial nerve. After the complete removal of the trapezium in a piecemeal fashion the entire width of the APL tendon is divided at its musculotendinous junction and then is flipped out to the first metacarpal insertion site. The first bone tunnel is made approximately 1 cm distal from the articular surface to the center of the first metacarpal base articular surface with a 3.2-mm– diameter cannulated drill. The second bone tunnel is made from the radiopalmar portion of the second metacarpal base (trapezial facet) to the ulnodorsal surface in the same manner. Subsequently the APL tendon is passed through the thumb and the index metacarpal tunnels (Fig. 2). The thumb metacarpal was positioned at the level of the index carpometacarpal joint when tensioning the APL tendon through the bone tunnels. Finally the free end of the APL tendon was sutured under manual tension to the extensor carpi radialis brevis tendon using an interweave-type juncture. Neither tendon interposition nor a temporary transfixing pin was applied in our series. A short-arm thumb spica splint was applied for 2 weeks and then range-of-motion and grip-strengthening exercises were initiated.
Soejima et al / APL Suspensionplasty
Results After surgery temporary paresthesia in the superficial radial nerve distribution was noted in 4 patients and metacarpophalangeal hyperextension remained in 2 thumbs. No patient required a revision surgery after this procedure. Subjective Outcomes Before surgery all patients (18 patients, 21 thumbs) reported pain when performing light daily activities; 7 patients (8 thumbs) complained of some pain even at rest. After surgery 13 of the 21 thumbs had no pain, 5 thumbs had mild pain with strenuous activity, and the remaining 3 thumbs had mild pain with light work. Sixteen patients believed that the reconstructed thumb was more effective for activities involving pinching and gripping than it had been before surgery, whereas the remaining 2 patients with metacarpophalangeal hyperextension noted some weakness when opening jars and using keys. No patient complained of any abduction weakness. Objective Outcomes The radial and palmar abductions improved from 42° ⫾ 24° to 56° ⫾ 9° (p ⫽ .094) and from 48° ⫾ 19° to 56° ⫾ 6° (p ⫽ .069), respectively. The grip and the key-pinch strengths also improved from 14 ⫾ 7 kg to 16 ⫾ 6 kg (p ⫽ .178) and from 2.7 ⫾ 1.8 kg to 4.0 ⫾ 1.2 kg (p ⫽ .225), respectively. The ratio of the height of the trapezial resection space divided by the length of the first metacarpal was decreased during the follow-up period from 0.20 to 0.17 (p ⫽ .004). This space, however, was preserved in the range of 0.17 to 0.16, even when performing the 2-kg key pinch (p ⫽ .045) in the final follow-up radiograph. The arthroplasty space was maintained in all patients and no patient showed any evidence of an impingement of the metacarpal against the scaphoid.
Discussion Thompson6 first described the suspensionplasty procedure using the APL tendon for cases of painful scaphometacarpal impingement after a trapeziectomy without either intercarpal ligament reconstruction or with the removal of silicone trapezium replacements. Recently Diao7 reported a cadaveric biomechanical analysis using a sonic digitizer tracking system to evaluate the efficacy of LRTI arthroplasty, Thompson’s suspensionplasty, and a modification of APL suspensionplasty in terms of maintaining thumb metacarpal position after a trapeziectomy. Based on his findings both Thompson’s suspensionplasty and the modified suspensionplasty had less proximal and dorsal migration than LRTI arthroplasty. As a result
427
this procedure therefore is considered to have some biomechanical advantages over standard procedures. Yang and Weiland3 observed a 21% subsidence of the first metacarpal at rest and an additional 11% subsidence during stress at a mean of 32 months after LRTI arthroplasties. Tomaino10 emphasized the importance of the temporary pin fixation of the thumb metacarpal to preserve the trapezial space, thereby restoring thumb strength. In our series neither tendon interposition nor a temporary transfixing pin was applied. The subsidence ratio decreased from 0.20 to 0.17 at rest; however, this ratio ranged from 0.17 to 0.16 even when performing a 2-kg key pinch at a mean of 33 months after surgery. As a result this suspensionplasty modality shows favorable stability of the thumb. Some investigators have found no correlation between the height of the arthroplasty space and the overall degree of patient satisfaction, pain relief, or improvement in the thumb function or strength.2,3,5,8,11 Belcher and Nicholl8 reported comparative results of trapeziectomy with and without LRTI using the APL tendon as a sling and concluded that the addition of a ligament reconstruction did not confer any additional benefit. In their 13-month follow-up series, however, marked scaphometacarpal abutment occurred in at least 2 of the total 42 thumbs after surgery in each group, and 1 patient in the LRTI group required revision surgery. Even if postoperative scaphometacarpal abutment after trapeziectomy did not cause any symptoms in a short period of follow-up evaluation this condition still may cause symptoms that may require revision surgery after long-term follow-up evaluation. The restoration of thumb stability should be essential at least in terms of preventing scaphometacarpal abutment after trapeziectomy. In this study metacarpophalangeal joint hyperextension remained in 2 thumbs without proximal first metacarpal subsidence after this procedure. These 2 patients with metacarpophalangeal joint hyperextension still felt some weakness when opening jars and using keys. Diao7 suggested that it would be better to perform capsulodesis of the metacarpophalangeal joint if a persistent hyperextension of greater than 30° was observed before surgery. One weakness of our study was the small number of patients and the short period of follow-up evaluation. Hence additional prospective randomized studies of larger numbers of patients with a longer follow-up period are needed. Thompson6 described the advantages of this procedure as follows: (1) technically it is easier to perform than some other procedures, (2) the APL tendon is removed as a deforming force, and (3) the flexor carpi radialis tendon is preserved as a wrist stabilizer. Diao7 also reported a modified technique of this procedure in
428
The Journal of Hand Surgery / Vol. 31A No. 3 March 2006
which the suspension point was established at a more distal point on the index metacarpal to obtain superior stability of the thumb. Another advantage of this procedure may be that the suspension point can be moved more distally at the surgeon’s discretion. The authors thank Edward Diao, MD, San Francisco, CA, for his constant interest and guidance throughout this study. Dr. Tatsuo Hanamura, the second coauthor of this article, suddenly passed away on August 20, 2005. The authors cordially dedicate this study to the memory of Dr. Hanamura, Ohita, Japan. Received for publication June 1, 2005; accepted in revised form December 1, 2005. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Corresponding author: Osamu Soejima, MD, PhD, Assistant Professor and Chief, Hand and Wrist Surgery Service, Department of Orthopaedic Surgery, Fukuoka University School of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan; e-mail: [email protected]. Copyright © 2006 by the American Society for Surgery of the Hand 0363-5023/06/31A03-0011$32.00/0 doi:10.1016/j.jhsa.2005.12.010
References 1. Burton RI, Pellegrini VD Jr. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg 1986; 11A:324 –332. 2. Lins RE, Gelberman RH, McKeown L, Katz JN, Kadiyala RK. Basal joint arthritis: trapeziectomy with ligament reconstruction and tendon interposition arthroplasty. J Hand Surg 1996;21A:202–209.
3. Yang SS, Weiland AJ. First metacarpal subsidence during pinch after ligament reconstruction and tendon interposition basal joint arthroplasty of the thumb. J Hand Surg 1998;23A: 879 – 883. 4. Gerwin M, Griffith A, Weiland AJ, Hotchkiss RN, McCormack RR. Ligament reconstruction basal joint arthroplasty without tendon interposition. Clin Orthop 1997;342:42– 45. 5. Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg 2004;86A:209 –218. 6. Thompson JS. Complications and salvage of trapeziometacarpal arthroplasties. Instr Course Lect 1989;38:3–13. 7. Diao E. Trapezio-metacarpal arthritis. Trapezium excision and ligament reconstruction not including the LRTI arthroplasty. Hand Clin 2001;17:223–236. 8. Belcher HJ, Nicholl JE. A comparison of trapeziectomy with and without ligament reconstruction and tendon interposition. J Hand Surg 2000;25B:350 –356. 9. Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg 1984;9A:692– 699. 10. Tomaino MM. Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis. Rationale, current technique, and clinical outcome. Hand Clin 2001;17:207–221. 11. Downing ND, Davis TR. Trapezial space height after trapeziectomy: mechanism of formation and benefits. J Hand Surg 2001;26A:862– 868. 12. Soejima O. [Suspensionplasty for osteoarthritis in the carpometacarpal joint of the thumb.] In: Takaoka K, ed. New NOW orthopaedic surgery. Vol. 22. Tokyo: Medical View, 2004:156 –160.