Thumb trapeziometacarpal arthritis: treatment with ligament reconstruction tendon interposition arthroplasty.
OBJECTIVE
After studying this article, the participant should be able to: 1. Understand the pathomechanical and biochemical basis for thumb trapeziometacarpal joint degeneration. 2. Diagnose and grade trapeziometacarpal joint disease based on presentation, physical examination (including provocative testing), and radiographic evidence. 3. Understand the principles of ligament reconstruction and tendon arthroplasty procedures. 4. Describe the surgical technique for ligament reconstruction tendon interposition arthroplasty and its variants.


BACKGROUND
Osteoarthritis of the trapeziometacarpal joint is the second most common site of degenerative joint disease in the hand, and mostly affects postmenopausal women. Degenerative arthritis of the thumb trapeziometacarpal joint is associated with a lack of bony constraints and laxity of the supporting ligaments, particularly the anterior oblique ("beak") ligament, which is consistently implicated in disease progression. Resultant increases in joint stress loads leads eventually to metacarpal and trapezial articular destruction, thumb instability, and pain.


METHODS
In this article, the authors review the diagnosis and treatment modalities available to the surgeon in the treatment of patients with trapeziometacarpal osteoarthritis. The technique of ligament reconstruction tendon interposition arthroplasty is discussed in detail.


RESULTS
Ligament reconstruction tendon interposition arthroplasty procedures center on three common principles: (1) excision of the diseased trapezium; (2) reconstruction of the beak ligament; and (3) interposition of a tissue substance to maintain metacarpal position.


CONCLUSIONS
Both conservative and surgical management can be effective in the treatment of trapeziometacarpal arthritis, when properly selected. The success of ligament reconstruction tendon interposition arthroplasty in treating trapeziometacarpal arthritis has withstood the test of time.
Ghavami
Ashkan
A
Department of Plastic and Reconstructive Surgery, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9132, USA. ashghavami@sbcglobal.net
Oishi
Scott N
SN
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D050279:Metacarpal Bones / Q000601:surgery*; D010003:Osteoarthritis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D011859:Radiography; D013165:Splints; D013709:Tendon Transfer; D013710:Tendons / Q000601:surgery; D013933:Thumb / Q000601:surgery*; D051222:Trapezium Bone / Q000601:surgery*
D000894:Anti-Inflammatory Agents, Non-Steroidal