J Korean Orthop Assoc.  2009 Apr;44(2):240-248.

Treatment of Subsesamoid Arthritis of the Metacarpophalangeal Joint of the Thumb: Volar Plate Reinforcing Technique after Sesamoid Excision

• Kim JP
• Yoo HY
• Min BK

Abstract

PURPOSE
To report the clinical outcomes of a volar plate reinforcing technique with free tendon grafts after sesamoid excision for the surgical treatment of subsesamoid arthritis of the metacarpophalangeal (MCP) joint of the thumb. MATERIALS AND METHODS: Eleven consecutive patients that underwent sesamoid excision and volar plate reinforcement using a palmaris longus free tendon graft were enrolled. There were 7 males and 4 females, with an average age of 46 (range, 30-56 years). Post-traumatic arthritis after a hyperextension injury of the thumb was present in 9 patients. Two patients had idiopathic arthritis. All patients were evaluated by objective and subjective criteria, the mean follow-up duration was 19 months (range, 12-35 months). RESULTS: The results were satisfactory overall (3 excellent, 7 good, 1 poor). The mean grip strength and pinch strength significantly improved from 63.0% and 51.3%, respectively, preoperatively, to 84.9% and 88.9%, postoperatively. The mean range of motion for the MCP joint was -5.9/50.9 degrees. The mean DASH and MHQ scores showed significant improvement compared to the preoperative scores. CONCLUSION: The early clinical results suggest that the described technique is a safe and effective option for subsesamoid arthritis of the MCP joint of the thumb.

Keyword

Thumb; Metacarpophalageal joint; Subsesamoid arthritis; Sesamoid excision; Volar plate reinforcing technique

MeSH Terms

Arthritis
Female
Follow-Up Studies
Hand Strength
Humans
Joints
Male
Metacarpophalangeal Joint
Pinch Strength
Range of Motion, Articular
Reinforcement (Psychology)
Tendons
Thumb
Transplants
Palmar Plate

Figure

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  Fig. 1 A lateral radiograph shows that the space between the metacarpal and sesamoid is narrowed with sclerosis (arrow).

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  Fig. 2 Arthroscopic examination shows a sesamoid with osteophyte formation and cartilage denuding, indicating sub-sesamoid arthritis (arrow head).

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  Fig. 3 Surgical approach. A inverted trapezoid skin incision, centered over the MCP joint of the thumb, is extended proximally into the palm within a skin crease over the distal portion of the thenar eminence.

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  Fig. 4 A photograph of excised both sesamoid bones shows that grossly degenerative changes developed in the radial sesamoid (asterisk).

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  Fig. 5 (A) A intraoperative photograph shows that two limbs of graft (arrow head) have been placed in each side of the flexor pollicis longus tendon (asterisk) and secured. (B) Schematic diagram of volar plate reinforcement with a free tendon graft of the MCP joint of the thumb.

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  Fig. 6 Photographs at final follow-up. (A) Postoperative active extension of the MCP joint of the thumb was to 0°. (B) Pinch strength was 90% of the value on the unoperated side.

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