title: Abductor pollicis longus hemitendon looping around the first intermetacarpal ligament as interposition following trapeziectomy: a one-year follow-up study.
abstract: BACKGROUND
  Trapeziectomy and ligament reconstructions are 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 trigger a complex regional pain syndrome type 1.
  
  
  OBJECTIVE
  Authors tested the looping of a slip from the abductor pollicis longus (APL) tendon around the first intermetacarpal ligament. They intended to use a surgical treatment which does not require bone tunnelling or looping around a tendon. Their results support the hypothesis that this new technique is a valid addition among treatments for carpometacarpal arthritis.
  
  
  METHODS
  Forty-two patients were followed up to one year. Each patient had subjective assessment for: pain; function (DASH score); overall satisfaction. An objective assessment was used for: first web span angle; abduction and opposition; key pinch; grip strength. Tests were performed prior to surgery, then at three, six and 12 months. X-ray films were taken to monitor thumb height.
  
  
  RESULTS
  A substantial improvement in all these 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.
  
  
  CONCLUSIONS
  Simplification and search for a technique which avoids the looping around a tendon is why the authors undertook this study. Advantages are the small number of required steps, short time of surgery and comfortable postoperative rehab regimen for the patient. The technique provides a distal anchoring 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 armamentarium for treating the thumb carpometacarpal joint osteoarthritis and/or to simplify the ligamentoplasties already in use.
authors: Orthopaedics and Hand Surgery, The Catholic University School of Medicine, Rome, Italy.
authors: L
authors: L
authors: Rocchi
authors: A
authors: A
authors: Merolli
authors: C
authors: C
authors: Cotroneo
authors: A
authors: A
authors: Morini
authors: F
authors: F
authors: Brunelli
authors: F
authors: F
authors: Catalano
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D052737:Carpometacarpal Joints / Q000601:surgery*; D005260:Female; D006801:Humans; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000601:surgery*; D010147:Pain Measurement; D011182:Postoperative Care; D011183:Postoperative Complications; D011859:Radiography; D013710:Tendons / Q000601:surgery*; D013933:Thumb / Q000000981:diagnostic imaging / Q000601:surgery*; D051222:Trapezium Bone / Q000601:surgery*