Clin Orthop Surg.  2015 Sep;7(3):372-376. 10.4055/cios.2015.7.3.372.

Results of Abductor Pollicis Longus Suspension Ligamentoplasty for Treatment of Advanced First Carpometacarpal Arthritis

• Lee HJ
• Kim PT
• Deslivia M
• Jeon IH
• Lee SJ
• Nam SJ

• KMID: 2234093
• DOI: http://doi.org/10.4055/cios.2015.7.3.372

Abstract

BACKGROUND
Suspension ligamentoplasty using abductor pollicis longus (APL) tendon without bone tunneling, was introduced as one of the techniques for treatment of advanced first carpometacarpal (CMC) arthritis. The purpose of this study was to evaluate the radiologic and clinical results of APL suspension ligamentoplasty.
METHODS
The medical records of 19 patients who underwent APL suspension ligamentoplasty for advanced first CMC arthritis between January 2008 and May 2012 were reviewed retrospectively. The study included 13 female and 6 male patients, whose mean age was 62 years (range, 43 to 82 years). For clinical evaluation, we assessed the grip and pinch power, radial and volar abduction angle, thumb adduction (modified Kapandji index), including visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Radiologic evaluation was performed using simple radiographs.
RESULTS
The mean follow-up was 36 months (range, 19 to 73.7 months). Mean power improved from 18.3 to 27 kg for grip power, from 2.8 to 3.5 kg for tip pinch, and from 4.3 to 5.4 kg for power pinch. All patients showed decreased VAS from 7.2 to 1.7. Radial abduction improved from 71degrees preoperatively to 82degrees postoperatively. The modified Kapandji index showed improvement from 6 to 7.3, and mean DASH was improved from 41 to 17.8. The height of the space decreased from 10.8 to 7.1 mm. Only one case had a complication involving temporary sensory loss of the first dorsal web space, which resolved spontaneously.
CONCLUSIONS
The APL suspension ligamentoplasty for treatment of advanced first CMC arthritis yielded satisfactory functional results.

Keyword

Thumb; Carpometacarpal joint; Osteoarthritis; Tendon; Suspension ligamentoplasty

MeSH Terms

Adult
Aged
Aged, 80 and over
Carpometacarpal Joints/*surgery
Female
Follow-Up Studies
Humans
Male
Middle Aged
Osteoarthritis/*surgery
Postoperative Complications
Retrospective Studies
Tendons/*surgery
Thumb/*surgery

Figure

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  Fig. 1 The abductor pollicis longus (APL) slip was wrapped two or three times around the flexor carpi radialis tendon to make a hammock, which suspended the base of the first metacarpal bone. The most distal end of the APL was put into the trapezial space after being fixed to the dorsal capsule.

• 

  Fig. 2 The immediate postoperative radiograph showed a trapezial space of 10 mm.

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  Fig. 3 The trapezial space decreased to 7.7 mm at 17 months after surgery.

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