gms | German Medical Science

Objectives/Interrogation: Tenosynovitis has occasionally occurred after Ligament Reconstruction without Tendon Interposition (LR without TI) for osteoarthritis of thumb trapeziometacarpal joint. The aims of this study were to investigate the relationship between pre/postoperative changes of Trapezial Space Height (TSH) and tenosynovitis and the influences of tenosynovitis to the results.

Methods: This retrospective study was composed of 33 patients (37 hands) who underwent LR without TI. After ligament reconstruction the K-wires were inserted to stabilize the thumb for 4 weeks. We assessed the TSH on the x-rays preoperatively and postoperatively at 2 weeks, 3 months and 12 months. We also assessed pain visual analog scale (VAS) preoperatively and postoperatively at 6 months and 12 months. 7 postoperative tenosynovitises were retrieved from the medical record. We found postoperative trigger finger of thumb with 1 patient, index finger with 4 patients and middle finger with 1 patient and carpal tunnel syndrome (CTS) with 1 patient. We diagnosed tenosynovitises 5.6 months postoperatively. 5 trigger fingers had been treated with corticosteroid injection 5.4 months postoperatively, 1 trigger finger without additional procedures and 1 CTS with endoscopic carpal tunnel release 8 months postoperatively. We compared the TSH and pain VAS between tenosynovitis and non-tenosynovitis group.

Results: The mean TSH of tenosynovitis and non-tenosynovitis group were 12.8mm and 12.3mm preoperatively (p=0.48), 7.1mm and 9.3mm 2 weeks postoperatively (p<0.01), 6.0mm and 6.9mm 3 months postoperatively (p=0.24) and 5.5mm and 6.1mm 12 months postoperatively (p=0.47). The mean degree of TSH shortening from preoperatively to 2 weeks postoperatively was 5.7mm and 3.0mm (p=0.01), from preoperatively to 3 months postoperatively was 6.8mm and 5.5mm (p=0.11) and from preoperatively to 12 months postoperatively was 8.1mm and 6.2mm (p=0.07). The mean pain VAS was 6.4 and 5.3 preoperatively (p=0.32), 2.2 and 1.9 6 months postoperatively (p=0.71) and 1.1 and 1.3 12 months postoperatively (p=0.89).

Conclusion: 2 weeks postoperatively, tenosynovitis group had significantly shorter TSH and larger degree of TSH shortening from preoperatively than non-tenosynovitis group. But there was no difference in pain VAS due to the treatment of tenosynovitis. We suggest that it may be preferable to insert the K-wires without compression the thumb toward proximal side after ligament reconstruction to minimize the potential of tenosynovitis.