A new abductor pollicis longus suspension arthroplasty.

PURPOSE: Surgical treatment of osteoarthritis of the first carpometacarpal joint aims to achieve complete pain relief with restoration of thumb strength and stability. The aim of this study was to introduce a variation of the abductor pollicis longus (APL) sling arthroplasty and to determine its efficacy in comparison with other tendon sling arthroplasty procedures.

METHODS

Between January 1999 and December 2003, 104 trapeziectomies in 74 consecutive patients (30 bilateral cases) were performed using a new APL sling arthroplasty. Patients were evaluated at 6 and 12 months after surgery. The outcomes were analyzed subjectively by questionnaire and objectively by clinical and radiographic evaluation.

RESULTS

After 6 months, excellent results in terms of pain relief were achieved in 95 thumbs (91%) of 65 patients. The remaining 9 thumbs had ongoing pain and had a secondary surgery performed between 6 and 12 months after the initial surgery. Pain relief was achieved in 1 thumb by scaphotrapezoid arthrodesis and in the other 8 thumbs by excision of the osteophyte on the ulnar-volar surface of the base of the first metacarpal, which was impinging on the base of the second metacarpal or the trapezoid. The gap was filled with a palmaris tendon anchovy. After 12 months, the 65 patients with successful trapeziectomies and APL sling remained pain-free. In these patients tip pinch, key pinch, and power grip strength increased by 46%, 19%, and 41%, respectively, from the preoperative values. In the 35 unilateral cases, tip pinch, key pinch, and power grip strength increased from 53%, 77%, and 65% of the contralateral hand strength before surgery to 82%, 89%, and 90%, respectively.

CONCLUSIONS

This modified APL sling arthroplasty is a new and effective way of creating a suspension sling with the APL tendon after trapeziectomy, with results comparable or better than other published methods, for the treatment of osteoarthritis of the first carpometacarpal joint.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.