Partial Arthroscopic Trapeziectomy and Stabilisation by Ligamentoplasty: Outcomes in Patients Younger than 60 Years.

Abstract

BACKGROUND\nThumb carpo-metacarpal joint (TCMJ) osteoarthritis is the fourth leading cause of referral to elective hand surgery. None of the available techniques has proved superior over the others. Some techniques carry unacceptable risks for younger patients, such as loss of strength and shortening of the thumb column after total trapeziectomy, or wear and loosening after total arthroplasty. Our objective was to assess outcomes after partial arthroscopic trapeziectomy (PAT) combined with suspensionplasty using the abductor pollicis longus (APL) tendon in patients younger than 60 years of age.\n\n\nHYPOTHESIS\nPAT combined with suspensionplasty using the APL tendon in patients younger than 60 years would restore strength in the medium term without further surgery.\n\n\nMATERIAL AND METHODS\nWe retrospectively included consecutive patients operated between 2007 and 2017, in a single centre, and aged less than 60 years. All patients had isolated TCMJ osteoarthritis stage 1 to 3 according to Eaton and Glickel classification that remained symptomatic despite optimal conservative treatment. We collected pain intensity, range of motion, strength, the Nelson Hospital Score (NHS), and the Patient-Rated Wrist Evaluation (PRWE) score. Radiographs were reviewed.\n\n\nRESULTS\nWe included 27 patients, of whom 6 had surgery on both thumbs, yielding 33 thumbs for the analysis. Mean follow-up was 64.7 months (range, 10.6-136.5 months). Pain intensity, grip strength, and key-pinch strength were significantly improved (p<0.001), with no difference between men and women. No differences were found for the Kapandji score (p=0.2) or TCMJ hyperextension (p=0.06). At last follow-up, the mean NHS was 83.2±19.4 and the mean PRWE was 15.4 ±17.9. Mean sick leave duration was 5.4 weeks (range, 1-24 weeks). Only 2 patients, both in manual jobs, were unable to return to work. The radiographs at last follow-up showed the development of moderate TCMJ narrowing in 14 patients and evidence of scapho-trapezio-trapezoid (STT) osteoarthritis in 10 patients. No patient experienced complex regional pain syndrome or injury to the sensory branch of the radial nerve. A single patient required further surgery for persistent pain.\n\n\nDISCUSSION\nPatients younger than 60 years who are treated with this minimally invasive technique are likely to experience sustained improvements in both strength and pain intensity. Total trapeziectomy and pyrocarbon implant has also been evaluated in younger patients, who experienced pain relief and strength gains but had lower levels of satisfaction and developed complications inherent in the implants. The short time off work and low morbidity make our technique a procedure of choice in younger patients. To build on this study, a comparison of PAT and arthroplasty would be of interest.\n\n\nLEVEL OF EVIDENCE\nIV.