Article
Does Ligament Reconstruction and Tendon Interposition (LRTI) destabilise the carpus?
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Authors
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Sten Deschuyffeleer
- University Hospitals Leuven, Leuven, Belgium
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Luc De Smet
- University Hospitals Leuven, Leuven, Belgium
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Ligament Reconstruction and Tendon Interposition (LRTI) is a commonly performed surgical intervention for trapeziometacarpal osteoarthritis. It entails removal of the trapezium, thus damaging the scaphotrapeziotrapezoid (STT) ligamentous complex. Despite the common use of this intervention, little is known about its effects on carpal stability. Only one retrospective study has actively researched this subject, analysing 22 wrist undergoing trapeziectomy as part of a variety of procedures, with a follow-up of 8,5 months. Results showed significantly increased radiolunate (RL) angles and revised carpal height (RCH) ratio. No corrections for differences in wrist flexion between pre- and postoperative radiographs were made. We present the results of the first prospective study specifically analysing the effect of LRTI on carpal stability.
Methods: 58 patients were enrolled, of which 25 were excluded because of loss to follow-up or inadequate radiographs. Pre- and postoperative PA and lateral radiographs from 34 wrists with a follow-up of at least one year were analysed for radioscaphoid (RS), radiolunate (RL), and radio-third metacarpal (RMC3) angles, as well as the revised carpal height (RCH, Natras method). The effect of wrist flexion (as measured by the RMC3 angle) on the RL angle was corrected for by subtracting half of the difference in RMC3 angle from the RL angle. Statistical analysis of the change in SL angle, RL angle and RCH was done with the paired t-test.
Results and Conclusions: We found a change in SL angle from 56,3° preoperatively (SD 10,1) to 56,8° postoperatively (SD 11,1), p = 0,7. The change in RL angle (uncorrected for wrist flexion) was from 6,0 (SD 9,4) to 7,4° (SD 11,8), p=0,4. When correcting for wrist flexion, the change in RL angle was from 0,3° (SD 13,5) to 3,2° (SD 11,8), p 0,04. There was no significant change in RCH, as the ratio changed from 1,61 to 1,58; p=0,3).
In conclusion, we found no statistically significant changes in SL angle or RCH, and a statistically significant but clinically insignificant change of the RL angle. These results seem to suggest that the short-term development of carpal instability should not be a concern after LRTI. Limitations of this study are the relatively short follow-up time, small sample size and the variation in wrist flexion between pre- and postoperative radiographs.
