Trapézectomies et ligamentoplasties de suspension au Gore-Tex® : résultats préliminaires sur 43 arthroses trapézométacarpiennes

Abstract

Trapeziectomy with suspension tendinoplasty is one of the most frequent procedures for the treatment of trapeziometacarpal arthritis of the thumb. The authors describe a new technique of total trapeziectomy and suspension tendinoplasty with Gore-Tex nonabsorbable monofilament. They give radiological and clinical results of their first 43 procedures with a minimum follow-up of 18 months. Forty-two patients (43 thumbs), average age of 61 years, underwent this procedure. According to Comtet's classification, they were 16 stage 1, 17 stage 2 and 10 stage 4. At 30 months average follow-up, 93% patients had good results on pain (Alnot's stage 0 or 1). The average opposition was 9.5 out of 10 according to Kapandji and the angle between the two first metacarpals was 36.5 degrees. The average key-pinch force was equal to 4.8 Kg. The average DASH score was 14.2. Collapse of the trapezial space was constant in the radiological study and at the follow-up, the trapezial space ratio was 63% of the preoperative ratio. The most frequent complication was reflex sympathetic dystrophy found in nine patients. The satisfaction rate was 88% and 93% of patients would agree to repeat this procedure. Our technique of suspension tendinoplasty with Gore-Tex monofilament has comparable results with those published with other transplants (Flexor carpiradialis, palmaris longus, abductor pollicis longus...). Our technique has some advantages over others: simplicity of surgical procedure without the need to harvest a tendon, no morbidity at the donor site and less time taken for the procedure. However, it still retains the advantages of suspension tendinoplasty.