J Korean Orthop Assoc.  2008 Feb;43(1):112-117. 10.4055/jkoa.2008.43.1.112.

Ligament Reconstruction for the Posttraumatic Instability of the Carpometacarpal Joint of the Thumb: A Report of Three Cases

• Park JS
• Kim HK
• Jung YK
• Yoo JH
• Kwon IH
• Rah J

• KMID: 2106425
• DOI: http://doi.org/10.4055/jkoa.2008.43.1.112

Abstract

Eaton and Littler's ligament reconstruction is used to treat carpometacarpal instability of the thumb using the flexor carpi radialis tendon. This procedure involves a reconstruction of the deep anterior oblique ligament in patients with post-traumatic prearthritic unstable joints. According to a recent paper, the dorsoradial ligament as well as the deep anterior oblique ligament plays an important role in stabilizing the trapeziometacarpal joint. We report three cases of post-traumatic instability in a prearthritic thumb that was treated with Eaton and Littler's reconstruction using the flexor carpi radialis tendon.

Keyword

Thumb; Deep anterior oblique ligament; Dorsoradial ligament; Instability; Ligament reconstruction

MeSH Terms

Carpometacarpal Joints
Humans
Joints
Ligaments
Tendons
Thumb

Figure

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  Fig. 1 (A) Radiograph showing the post-traumatic deformity at the thumb metacarpal base and subluxated trapeziometacarpal joint. (B) Ligament reconstruction and corrective osteotomy were performed. (C) Radiograph of the thumb carpometacarpal joints at 4 months. (D) Photographs of the hand at 26 months after surgery.

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  Fig. 2 (A) Photograph of left hand shows a protruded thumb carpometacarpal joint. Radiograph shows an almost dislocated trapeziometacarpal joint. (B) A ligament reconstruction and corrective osteotomy were performed. (C) Radiograph of the thumb carpometacarpal joints at 6 months. (D) Photograph of the hand at 25 months after surgery.

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  Fig. 3 (A) Photograph of the left hand shows a protruded thumb carpometacarpal joint. Radiograph shows an almost dislocated trapeziometacarpal joint. (B) A ligament reconstruction was performed. The thumb spica splint was applied. (C) Radiographs of the thumb carpometacarpal joints at 6 months. (D) Photograph of the hand at 23 months after surgery.

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  Fig. 4 Schematic diagram of the ligamentous anatomy of the trapeziometacarpal joint. Dorsoradial and deep anterior oblique ligament (dAOL) play the most significant role in stabilizing the trapeziometacarpal joint.

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  Fig. 5 (A) Diagram of the Eaton-Littler ligament reconstruction. Half of the flexor carpi radialis (FCR) was passed through a bony channel in the metacarpal base. The course of the tendon strip reinforces in the volar, dorsal, and radial aspect of the joint. (B) Ideal direction of the bony channel, which helps in the function of the dorsoradial ligament more effectively is shown.

Reference

1. Bettinger PC, Berger RA. Functional ligamentous anatomy of the trapezium and trapeziometacarpal joint (gross and arthroscopic). Hand Clin. 2001. 17:151–168.

2. Colman M, Mass DP, Draganich LF. Effects of the deep anterior oblique and dorsoradial ligaments on trapeziometacarpal joint stability. J Hand Surg [Am]. 2007. 32:310–317.

3. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am. 1973. 55:1655–1666.

4. Edmunds JO. Traumatic dislocations and instability of the trapeziometacarpal joint of the thumb. Hand Clin. 2006. 22:365–392.

5. Jebsen RH, Taylor N, Trieschmann RB, Trotter MJ, Howard LA. An objective and standardized test of hand function. Arch Phys Med Rehabil. 1969. 50:311–319.

6. Ozer K. A new surgical technique for the ligament reconstruction of the trapeziometacarpal joint. Tech Hand Up Extrem Surg. 2006. 10:181–186.

7. Pellegrini VD Jr, Parentis M, Judkins A, Olmstead J, Olcott C. Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: a biomechanical study. J Hand Surg [Am]. 1996. 21:16–23.

8. Rhee SK, Kim HM, Ahn HS. Treatment of osteoarthritis of the trapeziometacarpal joint. J Korean Soc Surg Hand. 1997. 2:251–260.

9. Shrivastava N, Koff MF, Abbot AE, Mow VC, Rosenwasser MP, Strauch RJ. Simulated extension osteotomy of the thumb metacarpal reduces carpometacarpal joint laxity in lateral pinch. J Hand Surg [Am]. 2003. 28:733–738.

10. Takwale VJ, Stanley JK, Shahane SA. Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament. J Bone Joint Surg Br. 2004. 86:541–545.