gms | German Medical Science

Introduction: Trapeziometacarpal joint arthritis is a frequent joint degenerative disease. Nowadays there are various surgical options available for the treatment of this pathology that provide good clinical results. The arthroscopic technique is offered as an alternative to the open surgical options providing the benefits of less tissue aggression, less post-surgery pain and the diagnose of chondral lesions not identified in radiographic studies.

Methods: The authors present 17 cases of trapeziometacarpal joint arthritis, Eaton-Littler stage III, treated in the ambulatory surgery unit. Most patients are female, mean age 61,38 ± 6,71 years-old. All patients were submitted to trapeziometacarpal chondroplasty, osteophyte removal and tendinous allograft interposition (semitendinous, semimembranosus or tibialis anterior muscle). The joint was stabilized with the use of a percutaneous trapezio-metacarpal K-wire. The patient used a wrist splint for 4 weeks and a wrist splint for 2 months at night. All patients were assigned a specific physical rehabilitation program for 4 weeks and were then evaluated clinically and functionally.

Results: The mean follow-up time was 20,29 months. The mean Visual Analogue Scale (VAS) improved from 8,47±0,83 before surgery to 1,63±0,96 after surgery. The anterior and lateral grip strength of the thumb improved from 3,81 Kg and 2,83 Kg before surgery to 6,4 Kg and 5,4 Kg after surgery, respectively. There were 3 cases of temporary hypoesthesia that resolved with cutaneus care and 2 cases of partial tendinous exteriorization that were resolved surgically. There were no complications related to the use of an allograft.

Discussion: Although there are multiple surgical options there isn't a consensus on the best technique for the treatment of the trapeziometacarpal joint arthritis.

This work shows the results of an arthroscopic technique with tendinous interposition applied to 17 patients, all performed by the same surgeon. The use of a tendinous allograft allows for less surgical injury and less surgery time.

Conclusions: The use of arthroscopic trapeziometacarpal chondroplasty and tendinous allograft interposition is a safe and reliable procedure that allowed to improve VAS and thumb grip strength. If these results endure and can be reproduced this procedure could be considered a "biological arthroplasty".