Outcome of trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: a prospective study

Abstract

<p><strong>Background</strong>: The purpose of this study is to assess the functional outcome of the cases with advanced thumb carpometacarpal (CMC) arthritis treated with trapeziectomy and ligament reconstruction tendon interposition (LRTI) in terms of visual analogue scale (VAS), disabilities of the arm, shoulder and hand (DASH) score, Kapandji score, range of motion (ROM) of radial and volar abduction of the thumb, grip power, key pinch and the height of the trapezial space.</p><p><strong>Methods</strong>: In a prospective before and after interventional study of 30 patients with the advanced thumb CMC joint arthritis underwent the procedure. An average follows up period was 17.9 months.</p><p><strong>Results:</strong> The mean VAS decreased from 8.17 to 2.70. The mean Kapandji score and DASH score improved from 3.47 and 71.62 preoperative to 8.23 and 14.46 postoperative. Mean ROM for radial and volar abduction increased from 42.57° and 48° to 61°and 64.73° respectively. Mean key pinch power and grip power increased from 2.80 kg and 3.47 kg to 4.70 kg and 9.01 kg respectively. There was a significant decrease in height of the trapezial space. Three patient complaint of the persistent pain at the surgical site and not much improvement in the DASH score.</p><p><strong>Conclusions:</strong> Trapeziectomy with LRTI using flexor carpi radialis (FCR) transfer is an effective treatment for the advanced thumb CMC arthritis. This procedure stabilizes thumb metacarpal and provide enough support which prevents the collapse of metacarpal into dead space.</p>