BACKGROUND:
Trapezial excision with ligament reconstruction and trapezial excision with
ligament reconstruction combined with tendon interposition have proven to be
highly effective techniques for treating primary osteoarthritis of the thumb
carpometacarpal joint. To determine whether tendon interposition and proximal
migration of the thumb metacarpal affect the objective and subjective
outcomes, we compared the long-term outcomes of these two procedures performed
in similar patient groups.
METHODS:
Forty-three patients (fifty-two thumbs) were randomized to undergo either
trapezial excision with ligament reconstruction orthe same procedure combined
with tendon interposition. Fifteen patients treated with ligament
reconstruction (group I) and sixteen patients treated with the same procedure
with concomitant tendon interposition (group II) were evaluated after a mean
follow-up period of 48.2 months. The outcomes were assessed with the
Buck-Gramcko score, with the total score calculated on the basis of the
objective and subjective results. The ability to perform activities requiring
use of the thumb and to return to work was analyzed as well. Radiographs were
evaluated to determine the amount of proximal metacarpal migration at rest and
under stress.
RESULTS:
Postoperatively, the mean total Buck-Gramcko score was rated as excellent
in group I and as good in group II (p = 0.036). Group I had significantly
better mean scores for palmar and radial abduction, cosmetic appearance, and
willingness to undergo the surgery again under similar circumstances (p <
0.05). The mean scores for tip-pinch strength and the mean subjective scores
for pain, strength, daily function, dexterity, and overall satisfaction did
not differ significantly between the groups. Both groups had satisfactory
results with regard to their performance of activities of daily living and
their ability to return to work. With the numbers available, the amount of
proximal metacarpal migration, at rest and under stress, did not differ
significantly between the groups.
CONCLUSIONS: