Abductor pollicis longus hemi-tendon looping around the first intermetacarpal ligament as interposition following trapeziectomy: A one-year follow-up study|Mise en boucle de l'hemi-tendon de l'abductor pollicis longus autour du premier ligament intermetacarpien comme interposition post-trapeziectomie: une étude à un an de recul

Background: Trapeziectomy and ligament reconstruction is favoured by surgeons concerned that telescoping of the thumb may reduce its function. However, theoretically ligamentoplasties are at risk to develop tendinosis or tendon rupture or trigger a complex regional pain syndrome type 1. Hypothesis: Authors tested the looping of a slip from the Abductor Pollicis Longus tendon around the first intermetacarpal ligament. They intended to use a surgical treatment, which does not require bone tunneling or looping around a tendon. Their results support the hypothesis that this new technique is a valid addition among treatments for carpo-metacarpal arthritis. Patients and Methods: Forty-two patients were followed-up to 1 year. Each patient had subjective assessment for: pain; function (DASH score); overall satisfaction. An objective assessment was used for: first web span angle; abduction and opposition; key pinch; grip strength. Tests were performed prior to surgery, then at 3, 6 and 12 months. X-ray films were taken to monitor thumb height. Results: A substantial improvement in all these parameters was measured in all patients. X-ray films showed the maintenance of a physiological height after one year. We recorded one complication of keloid and two of temporary dysesthesia but no case of tendinosis, delayed rupture, or CRPS 1. Mean operative time was 27. minutes. Discussion: Simplification and search for a technique, which avoid the looping around a tendon is why the authors undertook this study. Advantages are the small number of required steps, short time of surgery and comfortable postoperative rehab regimen for the patient. The technique provides a distal anchoring point (without bone tunneling). It is quite respectful of anatomy and physiology, in minimizing the re-routing of functioning tendons. We propose it as an effective procedure both to expand the armamentarium for treating the thumb carpo-metacarpal joint osteoarthritis and/or to simplify the ligamentoplasties already in use. Level of evidence: Level IV. Retrospective therapeutic study. © 2011 Elsevier Masson SAS.