Thumb Carpometacarpal Arthroplasty Using an Absorbable Interference Screw for Flexor Carpi Radialis Ligament Reconstruction

Abstract

Few surgical techniques that address advanced thumb carpometacarpal osteoarthrosis specifically allow early mobilization postoperatively. After trapeziectomy, we carry out a ligament reconstruction using an absorbable interference screw to secure a flexor carpi radialis tendon autograft within the first metacarpal base. Theoretically, superior tendon graft fixation strength allows early mobilization within 2 weeks postoperatively. We have retrospectively compared our clinical results using this technique with another group of patients who underwent traditional ligament reconstruction and tendon interposition as described by Burton and Pellegrini. There were no differences in the verbal pain score, satisfaction rating, or DASH scores between groups. There was a statistically significant decrease in trapezial space ratio both at rest and with stress for the experimental group. Although the clinical significance of this finding is largely unknown, it did not correlate with clinical outcome in our patients. Although no conclusions could be drawn regarding early mobilization after thumb carpometacarpal arthroplasty, further studies are planned to investigate this intriguing aspect of postoperative care. In this article, we present the details of the surgical technique and postoperative rehabilitation.

Anomalous Bicipital Origin of Flexor Carpi Radialis Muscle: A Cadaveric Study

“…Both congenital absence [2] and duplication in the form of two separate musculotendinous units, a FCR and a FCRB (flexor carpi radialis brevis) have been reported [4]. Further importance of FCR muscle has been documented and studies have highlighted the use of supernumerary tendons of FCR muscle as interpositional graft during reconstructive surgeries [9,10]. Accordingly, variant FCR with small belly and long tendon has been reported to be beneficial to surgeons undertaking regional reconstructive surgeries and also to physiotherapists for making better post reconstructive rehabilitation planning [3].…”

Tendinous flexor carpi radialis: A case report

“…The uses of ten dons of the FCR in various reconstruc tive surgeries that involve the wrist and hand have been well documented owing to its dispensability [8][9][10][11][12][13] . The common use of the tendon of FCR is in the interpositional graft in the treatment of arthritis of the first carpometacarpal joint and also in opponensplasty 9,10 , in which, part of the tendon or the entire tendon may be used. In cases, such as the one presented here, the increase in length of the tendon might possibly provide more connective tissue if required in certain cases, where the entire ten don is used.…”