First Carpometacarpal Joint Instability: Dorsal Ligament Reconstruction.

The first carpometacarpal (CMC-I) joint has an elaborate ligamentous support. Recent evidence has demonstrated that the dorsal ligament group is imperative for joint stability and that CMC-I joint instability may occur as a consequence of trauma and ligamentous laxity, and other conditions, with possible CMC-I subluxation and the development of osteoarthritis. Although various surgical techniques have been introduced for the treatment of ligamentous CMC-I instability, the Eaton-Littler reconstruction has been regarded as the gold standard. It is widely accepted that impaired hand function may still be present following the reconstruction of the CMC-I joint ligaments, demonstrating the existing limitations of current surgical techniques. In this paper, a novel extra-articular technique relating to CMC-I joint instability and focusing on the dorsal ligament group is described. A graft taken from the abductor pollicis longus tendon is utilized to reconstruct the dorsal radial ligament and posterior oblique ligament. This technique may provide a less invasive alternative than the gold standard procedure and the hypothesis is that it will lead to a better outcome.