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The Long-Term Outcomes of Ligament Reconstruction in Non-Traumatic Thumb Carpometacarpal Instability: An 8 Year Follow-Up of 177 Patients
Niek J. Nieuwdorp, MSc
1, Isabel C. Jongen, MD
1, Mark J. W. van der Oest, MD, PhD
1, Thybout M. Moojen, MD, PhD
2, Ruud W. Selles, PhD
1, Caroline A. Hundepool, MD, PhD
1, The Hand Wrist Study Group, .
1,2; J. Michiel Zuidam, MD, PhD
1(1)Erasmus MC, Rotterdam, Netherlands, (2)Xpert Clinics, Amsterdam, Netherlands
Introduction: Thumb carpometacarpal (CMC) joint instability, typically due to ligament laxity, is most common in young females and can lead to pain and impaired hand function. Although it may resemble early-stage osteoarthritis (Eaton-Glickel stage 1) clinically, CMC instability occurs without degenerative changes and should be regarded as a distinct condition requiring a specific treatment approach, ranging from targeted hand therapy to stabilizing surgery. Ligament reconstruction for CMC instability remains controversial due to uncertainties regarding its long-term effectiveness and progression to osteoarthritis. However, long-term studies are lacking. This study aimed to assess the long-term outcomes of ligament reconstruction for non-traumatic CMC instability and compare the Eaton-Littler and figure-of-eight techniques.
Material & Methods: This prospective cohort study included patients with non-traumatic CMC instability undergoing ligament reconstruction, excluding those with CMC joint chondropathy. Patients were treated with either the Eaton-Littler technique or the figure-of-eight technique. (Figure 1) The primary outcomes were pain and hand function, assessed at baseline, 12 months, and long-term follow-up using the Michigan Hand Outcome Questionnaire (MHQ, 0-100). Secondary outcomes included satisfaction and additional treatments for CMC joint complaints.
Results: A total of 177 patients were included (mean follow-up 8 years); 135 underwent the Eaton-Littler and 42 the figure-of-eight technique. Both techniques significantly improved MHQ pain (from 35 to 63) and function (from 53 to 70) at 12 months (p < 0.001). Trapeziectomy was performed in 5% of patients for progression to osteoarthritis. Among patients who did not require trapeziectomy, further improvements were seen in pain (p = 0.002) and function (p < 0.001) over long-term follow-up. At final follow-up, 86% of patients in the Eaton-Littler group and 79% in the figure-of-eight group reported being satisfied with their outcome. Additional treatment after 12 months was required in 15% of Eaton-Littler and 26% of figure-of-eight patients, including reoperation in 3% and 5%, respectively. No significant differences were observed between techniques.
Conclusions: The findings suggest that the controversy surrounding ligament reconstruction for non-traumatic CMC instability may be unfounded. Only a few patients required trapeziectomy due to osteoarthritis progression, while most experienced long-term improvement in pain and function with high satisfaction. Both surgical techniques demonstrated long-term effectiveness and durability, with no significant differences in outcomes between them.
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