Arthroscopic Hemitrapeziectomy and Extensor Carpis Radialis Longus Suspensioplasty With Intermetacarpal Ligament Reconstruction for Thumb Carpometacarpal Joint Osteoarthritis: Surgical Technique

Abstract

Most of the classical reconstructive procedures for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis consist of partial or complete trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Traditionally, this was performed with an open approach. In the last 2 decades, emerging arthroscopic techniques have been developed. Although more technically challenging, arthroscopic management of CMC pathology provides the potential benefits of minimally invasive surgery. Despite several different arthroscopic approaches that exist, in recent years, arthroscopic hemitrapeziectomy with suture button (SB) suspensionplasty has become popular, with overall good outcomes. However, several complications associated with the SB device have been described as requiring secondary surgery. In this report, we present and describe a new surgical technique for arthroscopic treatment of thumb CMC osteoarthritis that combines the benefits of arthroscopic management with the potential advantages of ligament reconstruction by creating a real anatomical and biological reconstruction of the intermetacarpal ligament using a distally based strip of the extensor carpi radialis longus (ECRL) tendon with a minimally invasive approach. Our ongoing research data show encouraging preliminary clinical and radiologic outcomes at the latest follow-up, with further studies forthcoming. Level of Evidence: Level IV.