Ligament Reconstruction of the Thumb Carpometacarpal Joint using a Modified Eaton and Littler Technique

Abstract

A modification of the Eaton and Littler technique for reconstructing ligaments and restoring stability of the carpometacarpal joint of the thumb is described. We use a strip from the flexor carpi radialis tendon, which is split down to the crest of the trapezium. The tendon strip is led beneath the ligaments and the abductor pollicis longus insertion, through a tunnel drilled in the metacarpal base, around the insertion of the flexor carpi radialis tendon and finally back to the dorsum of the base of the metacarpal where it is inserted in the periosteum. This procedure ensures a dynamic fixation of the apical ligament and therefore a better stability.

Revision of Thumb Trapeziometacarpal Arthroplasty

“…Surgical options include the use of a tendon 1,2,4,9,10 -12,16 reconstruction for support ligaments including tendon slips from the flexor carpi radialis (FCR), APL, 10,12,19,21,24,26,27 or ECRL, 8,11 depending on which primary procedure was performed initially and which tendons were not involved. In the case of clear clinical instability a ligament reconstruction is preferred by techniques that replace the TMC ligaments.…”

“…Among the remaining 606 patients we identified 15 patients with 17 thumb arthroplasties (see Appendix A for details; this appendix may be viewed at the Journal's Web site, www.jhandsurg.org) who had a revision surgery procedure performed after a failed primary soft-tissue arthroplasty of the thumb TMC joint for mechanical-related pain and/or instability. The primary procedures for thumb TMC arthritis included extensor carpi radialis tendon ligament plasty (n ϭ 14) 8 ; abductor pollicis longus and flexor carpi radialis interposition; Weilby procedure (n ϭ 365) [10][11][12]19 ; tendon interposition with ligament reconstruction with the flexor carpi radialis (LRTI); Burton-Pellegrini or Eaton-Littler procedures (n ϭ 152) 2,4,10 ; anchovy interposition of tendon (n ϭ 66) 6,16 ; or Gelfoam (Pfizer Pharmaceuticals, Cambridge, MA) (n ϭ 9). 7 The primary procedures for each of the 17 failed arthroplasties were the Eaton-Littler procedure (n ϭ 4), Weilby procedure (n ϭ 5), LRTI procedure (n ϭ 3), hemiresection of the trapezium (n ϭ 2), and trapezial excision with tendon interposition (n ϭ 3).…”

“…[1][2][3][4][5][6][7][8][9][10][11][12] Failure of this surgery to achieve the intended result of pain-free thumb motion and improved pinch and grasp is uncommon, 1,2,4,9,13,14 but when it occurs the surgeon must determine carefully the reason for continued pain and weakness and then weigh different options to select the best course of surgical or nonsurgical treatment. Conservative measures can be successful 15 but if they fail then revision surgical treatment may be necessary.…”

The Influence of Evidence in the Surgical Treatment of Thumb Basilar Joint Arthritis

“…15,16 Many believed that these procedures addressed concerns about loss of thumb height and stability of the thumb metacarpal. 14,17–20 …”

Description and Outcomes of a New Technique for Thumb Basal Joint Arthroplasty

“…The most commonly performed surgery today is the ligament reconstruction tendon interposition (LRTI) described by Burton and Pelligrini. 7 Other commonly performed surgeries include the FCR suspensionplasty (and variations) described by Weilby 8 and Magnussen et al 9 and the APL suspensionplasty (and variations) described by Thompson 10 and Diao. 11 More recently, an APL suspensionplasty in which the APL is looped around both the FCR and the ECRL has been described.…”