Clin Orthop Surg.  2019 Dec;11(4):453-458. 10.4055/cios.2019.11.4.453.

Trapeziectomy with Ligament Reconstruction and Interposition Arthroplasty Using the Palmaris Longus Tendon: An Average 5-Year Follow-up

Affiliations
  • 1Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan. dkawa@pop06.odn.ne.jp
  • 2Keiyu Orthopaedic Hospital, Tatebayashi, Japan.

Abstract

BACKGROUND
Trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with the flexor carpi radialis (FCR) tendon is one of the most common procedures for the treatment of trapeziometacarpal osteoarthritis. We modified the LRTI, using the palmaris longus (PL) tendon instead of the FCR tendon. The aim of this retrospective study was to evaluate the clinical outcomes of trapeziectomy with our modified LRTI procedure at a mean follow-up of 5 years.
METHODS
Fourteen thumbs in 13 patients (12 women) with a mean age of 64 years (range, 50 to 77 years) were available for assessment for a mean duration of 62 months (range, 41 to 97 months). The patients were evaluated subjectively and objectively.
RESULTS
The modified LRTI procedure provided good pain relief, motion, strength, and stability without any severe complications related to the PL tendon harvesting. Radiography showed that compared to the preoperative status, the trapezial space decreased by about 40% at the final follow-up.
CONCLUSIONS
The modified LRTI procedure provided significant subjective and objective improvements without severe complications particularly related to the harvesting of the PL tendon. This procedure is a valuable surgical option for trapeziometacarpal osteoarthritis and could be a useful salvage modality if the FCR tendon ruptures during the conventional LRTI procedure.

Keyword

Thumb; Carpometacarpal joints; Osteoarthritis; Arthroplasty

MeSH Terms

Arthroplasty*
Carpometacarpal Joints
Follow-Up Studies*
Humans
Ligaments*
Osteoarthritis
Radiography
Retrospective Studies
Rupture
Tendons*
Thumb

Figure

  • Fig. 1 Schema showing our modified ligament reconstruction and tendon interposition arthroplasty. (A) The distal end of the palmaris longus (PL) tendon was delivered through the bone tunnel at the first metacarpal bone. (B) The distal end of the PL tendon was sutured to the flexor carpi radialis with an interlacing suture at the site just proximal to its insertion. (C) The other end of the PL tendon was sutured to the periosteum and interweaved to itself in the trapeziectomy space. (D) I: The remaining proximal end of the PL tendon was unrolled in transverse direction to form a sheet. II-IV: The bone core was rolled up with the PL sheet to make a tendon ball with a bone core. The trapeziectomy space was filled with the bone-core tendon ball (curved arrows).

  • Fig. 2 Intraoperative photographs. (A) The distal end of the palmaris longus (PL) tendon (asterisk) was passed through the bone tunnel at the first metacarpal bone. (B) The distal end of the PL tendon (asterisk) was passed through the flexor carpi radialis (arrowhead) by using a tendon passer. (C) The trapeziectomy space was filled with the bone-core tendon ball (arrow).

  • Fig. 3 Preoperative (A), 1-day postoperative (B), and 59-month postoperative (C) radiographs of a 63-year-old patient with trapeziometacarpal arthritis of Eaton and Glickel grade III.


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