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Arthroscopic Partial Trapeziectomy with Soft Tissue Interposition for Symptomatic Trapeziometacarpal Arthritis
Jonathan Twu, BS1; Kenneth J. Korcek, MD2; Brian Bear, MD2;
1University of Illinois College of Medicine in Rockford, 2Rockford Orthopedic Associates

Objective: To determine if arthroscopic partial trapeziectomy and soft tissue interposition arthroplasty is an effective treatment for symptomatic trapeziometacarpal arthritis.

Methods: We retrospectively evaluated 30 consecutive patients with symptomatic thumb trapeziometacarpal arthritis Eaton-Littler stage 2 and 3. Treatment consisted of an arthroscopic partial trapeziectomy with soft tissue interposition utilizing an acellular dermal matrix as the interposition material. Post-operative care consisted of six weeks of thumb spica immobilization followed by four weeks of hand therapy comprised of range of motion and strengthening exercises. We evaluated pre-operative and post-operative visual analog patient reported pain, patient reported satisfaction, post-operative grip strength, appositional pinch strength, oppositional pinch strength, post-operative arthroplasty space and QuickDASH scores. The follow-up was an average of 12 months after surgery (Range: 6 – 24 months).

Results: 30 of 30 patients reported a reduction in pain. Pre-operative visual analog reported pain was averaged 8.2 and decreased to an average of 1.3 after surgery. (p < .00) 27 of 30 patients were satisfied with the outcome of the surgery. 27 of 30 patients would proceed with the same procedure again. 26 of 30 patients would recommend it to a friend. Satisfaction was directly correlated with a decrease in visual analog pain scores. (r = -.43, p = .02) 29 thumbs adducted fully in the plane of the palm and opposed the fifth metacarpal head. Post-operative grip, oppositional pinch and appositional pinch strength were 97%, 93% and 85% of the contralateral hand respectively. The mean arthroplasty space was 1.5 mm in satisfied patients and 1.0 mm in dissatisfied patients with a significant correlation between dissatisfaction and lower post-operative arthroplasty space. (p = .018) Pre-operative QuickDASH outcome scores were obtained and 10 patients averaged 42. Post-operative QuickDASH scores were obtained in those 10 patients and averaged 23 while the average of all 30 patients was 19. (p = .03)

Conclusion: Short term analysis demonstrates that arthroscopic partial trapeziectomy with soft tissue interposition arthroplasty utilizing an acellular dermal matrix as the interpostion material provides satisfactory pain relief, patient satisfaction, thumb motion and strength.

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