[Revision surgery after resection arthroplasty of the CMC-1 joint using the extensor carpi radialis longus muscle tendon].

Abstract

OBJECTIVE\nResuspension of the first metacarpal bone using the extensor carpi radialis longus muscle tendon. Prevention of contact between the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Preservation of motion.\n\n\nINDICATIONS\nPain after preceeding resectional arthroplasty due to proximalisation of the first ray. Radiologically demonstrated contact between the base of the first metacarpal bone and adjacent bones (scaphoid, trapezoideum, second metacarpal bone). Instability of the first ray at the site of the suspension.\n\n\nCONTRAINDICATIONS\nProven specific reasons: neuropathical complaints and dysaesthesia in the region supplied by the superficial branch of the radial nerve, tendinitis of the flexor carpi radialis tendon etc. SURGICAL TECHNIQUE: Distalisation of the first ray after mobilisation and debridement at the base of the first metacarpal bone with resection of scar tissue, Resection of the pre-existing tendon plasty and contouring the base of the first metacarpal bone with removal of osteophytes. Interposition of tendon material between the base of the first and second metacarpal bones.\n\n\nPOSTOPERATIVE MANAGEMENT\nImmobilisation in a\xa0forearm cast including the thumb metacarpophalangeal joint for 6\xa0weeks.\n\n\nRESULTS\nOf 21\xa0patients treated using this procedure, 15\xa0(13\xa0women, 2\xa0men, average age 59\xa0(51-70)\xa0years) were evaluated retrospectively on average 4\xa0(2-10)\xa0years postoperatively. Opposition of the thumb was nearly normal. Grip strength and strength of pinch grip did not differ significantly from the contralateral side. Pain at rest and exercise (evaluated by a\xa0visual analogue scale from 0-10) was postoperatively significantly reduced. On plain X‑rays the distance between the base of the first metacarpal bone and the distal scaphoid pole was significantly increased as a\xa0sign of a\xa0successful distalisation. Ultimately, 12\xa0patients postoperatively returned to work, 10\xa0to their original occupation. No patient required additional procedures.