title: Ligament reconstruction with tendon interposition arthroplasty for first carpometacarpal joint osteoarthritis.
abstract: BACKGROUND
  Ligament reconstruction tendon interposition (LRTI) is the most commonly performed surgical procedure for first carpometacarpal joint osteoarthritis. The purpose of this study was to examine the radiographic and clinical outcomes of LRTI arthroplasty and document the clinical results based on metacarpal subsidence.
  
  
  METHODS
  From January 2008 to January 2011, 19 patients (21 thumbs) underwent surgery for thumb carpometacarpal arthritis using ligament reconstruction tendon interposition arthroplasty with flexor carpi radialis (FCR) in Kleinert Kutz Hand Care Center of Louisville University, USA. The follow-up period was an average of 13.9 months. Pain, grip strength, tip pinch strength, range of motion, and radiographic measurements were recorded. Based on first metacarpal subsidence, the cases were classified in to mild, moderate, and severe. Clinical outcomes of the groups were evaluated and compared.
  
  
  RESULTS
  Grip strength improved from 18.6 kg to 20.5 kg, and tip pinch strength increased from 4.4 kg to 4.5 kg after the surgery. Radial abduction and palmar abduction improved after surgery. Radial abduction increased from 55.7° to 60.6° and palmar abduction improved from 56.7° to 63.5° after the procedure. Visual analogue scores (VAS) were significantly reduced, from 6.6 to 0.5. Compared with the preoperative radiographs the first metacarpal had subsided about 54.6% of the arthroplasty space. The height of arthroplasty space and index of the arthroplasty space significantly decreased from 12.4 mm to 5.6 mm and from 0.27 to 0.12 respectively. Between the various groups (mild, moderate and severe metacarpal subsidence), there was no difference in grip strength, tip pinch strength, thumb range of motion, and VAS.
  
  
  CONCLUSIONS
  Ligament reconstruction tendon interposition arthroplasty resulted in excellent relief of pain and increase in range of motion. However, LRTI cannot maintain the arthroplasty space. Compared with the preoperative radiographs, the metacarpal subsided more than 50%. The amount of first metacarpal subsidence has no bearing on the results.
authors.affiliation: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville, Louisville 40202, KY, USA. Email: htien@kleinertkutz.com.
authors.forename: Huey Y
authors.initials: HY
authors.lastname: Tien
authors.affiliation: Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville, Louisville 40202, KY, USA.
authors.forename: Kannan K
authors.initials: KK
authors.lastname: Kumar
authors.affiliation: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Shanlin
authors.initials: S
authors.lastname: Chen
authors.affiliation: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Zhongzhe
authors.initials: Z
authors.lastname: Li
authors.affiliation: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Tian
authors.affiliation: Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing 100035, China.
authors.forename: Guanglei
authors.initials: G
authors.lastname: Tian
mesh_terms: D000368:Aged; D001178:Arthroplasty / Q000379:methods*; D052737:Carpometacarpal Joints / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D013933:Thumb / Q000601:surgery