Abductor pollicis longus hemitendon looping around the first intermetacarpal ligament as interposition following trapeziectomy: a one-year follow-up study.

Background. Trapeziectomy and ligament reconstruction is favoured by surgeons concerned that telescoping of the thumb may reduce its function. However, theoretically ligamentoplasties are at risk to develop tendinosis or tendon rupture or a complex regional pain syndrome type 1. Hypothesis of the article. Authors tested the looping of a slip from the Abductor Pollicis Longus tendon around the first intermetacarpal ligament, aiming at a surgical treatment which does not require bone tunneling or looping around a tendon. Our results support the hypothesis that this new technique is a valid addition among treatments for carpo-metacarpal arthritis. Materials and Methods. Forty-two patients were followed-up to one year. Each patient had subjective assessment for: -pain; -function (DASH) -overall satisfaction. An objective assessment was enterprised for: -first web span angle; -abduction and opposition; -key pinch; -grip strength. Tests were performed prior to surgery, then at 3, 6 and 12 months. X-ray films were taken to monitor thumb height. Results. A significative improvement in all the parameters was measured in all patients. X-ray films showed the mantainance of a physiological heigth after one year. We recorded one complication of keloid and two of temporary dysesthesia but no case of tendinosis, delayed rupture, or CRPS 1. Mean operative time was 27 minutes. Discussion. Simplification and search for a technique which avoid the looping around a tendon is why the authors enterprised this study. Advantages are the little number of steps, short time of surgery and comfortable postoperative prescriptions for the patient. The technique provides a distal suspension point (without bone tunnelling). It is quite respectful of anatomy and physiology, in minimizing the re-routing of functioning tendons. We propose it as an effective procedure both to expand the "weaponary" for treating the CMC osteoarthritis and/or to simplify the ligamentoplasties already in use.