Clinical Outcomes of Volar Oblique Ligament Reconstruction in Thumb Basal Joint Arthritis

Abstract

Introduction: Volar oblique ligament (VOL) is known as a primary trapeziometacarpal joint stabilizer. Because ligament laxity is one of most important cause of thumb basal joint arthritis, Eaton and Littler introduced their technique reconstructing VOL as a treatment of that; however, they recommended using this treatment only for Eaton-Littler stages I and II through their study result. We evaluated clinical outcomes of VOL reconstruction applied for patients with stage I, stage II, and even early stage III thumb basal joint arthritis. Material and Methods: We analyzed 21 patients who had undergone surgery for thumb basal joint arthritis in our hospital from May 2011 to October 2014 and had a minimum 12 month follow-up. All patients were women and the mean age at diagnosis was 58.5 years (range, 43-78 years). Six patients were Eaton stage I, 9 were II, and 6 were III. Functional outcome were evaluated using New York Orthopedic Hospital Wrist Scoring Scale, which assessed range of motion (ROM), grip power, radiologic findings, pain, and hand function. The stability of basal joint and progression of arthritis were also evaluated. Wilcoxon rank sum test was used for statistical analysis. The mean follow-up period was 21.6 months (12-56 months). Result: The overall functional results according to New York Orthopedic Hospital Wrist Scoring Scale were 1 excellent, 10 good, 7 fair, and 3 poor. We divided two groups (Eaton stage I, II vs III) and analyzed nonparametric test; however, it did not show a significant difference ( P = .856). Two of 6 patients with stage III osteoarthritis showed poor result. At last follow-up, average grip power was 83.3% of normal side. The stability of VOL-reconstructed basal joint were restored and maintained in 15 of 21 joints. The arthritis was progressed in 4 joints, 1 of 6 Eaton stage I, 1 of 9 Eaton stage II, and 2 of 6 Eaton stage III joints. Conclusion: Our results suggested that VOL reconstruction is a reliable method for management of Eaton stage I and II osteoarthritis and can be applied even in early Eaton stage III osteoarthritis before performing salvage procedures.