Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis - A prospective randomized study

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 or the 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: Tendon interposition does not affect the outcome after the ligament reconstruction for the treatment of osteoarthritis of the thumb carpometacarpal joint. Furthermore, proximal migration of the thumb metacarpal does not appear to influence the functional outcome. Level of Evidence: Therapeutic study, Level I-1a (randomized controlled trial [significant difference]). See Instructions to Authors for a complete description of levels of evidence.