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ligament reconstruction and tendon interposition

Nikolas H Kazmers, K J Hippensteel, Ryan P Calfee, Lindley B Wall, Martin I Boyer, Charles A Goldfarb, Richard H Gelberman, Daniel A Osei
BACKGROUND: Trapeziometacarpal arthrodesis (TMA) has been complicated by nonunion and hardware failure. QUESTIONS/PURPOSES: We hypothesized that modification of the TMA technique with a locking cage plate construct would afford reliable bony union while producing greater hand function than trapeziectomy with ligament reconstruction and tendon interposition (LRTI) at early follow-up. METHODS: We enrolled 36 consecutive patients with trapeziometacapal osteoarthritis (14 TMA patients (15 thumbs), 22 LRTI patients (22 thumbs))...
February 2017: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Frank Yuan, Oluseyi Aliu, Kevin C Chung, Elham Mahmoudi
PURPOSE: Thumb carpometacarpal (CMC) arthritis contributes considerably to functional disability in the aging adult United States (US) population. Owing to the increasing growth in this segment of our population, its burden on health care resources will increase in the future. Variations exist in the degree of complexity and cost among different surgical treatments. We examined the national trends of the surgical treatment of thumb CMC arthritis and hypothesized that current practice patterns are not supported by evidence favoring the simpler trapeziectomy-only procedure...
February 2017: Journal of Hand Surgery
Mihir J Desai, David M Brogan, Marc J Richard, Suhail K Mithani, Fraser J Leversedge, David S Ruch
Background: The purpose of this study was to compare the initial biomechanical strength of trapeziectomy and suture-button suspensionplasty (SBS) with ligament reconstruction and tendon interposition (LRTI) for thumb carpometacarpal (CMC) arthritis in a cadaveric model. Methods: Eight matched pairs of below-elbow cadaveric arms were used for this study. Each specimen was randomly assigned to either receive a trapeziectomy and LRTI (LRTI group) or trapeziectomy and SBS (SBS group). Using previously described and validated testing protocols, physiological key pinch was simulated...
December 2016: Hand: Official Journal of the American Association for Hand Surgery
Anita Sadhu, Ryan P Calfee, Andre Guthrie, Lindley B Wall
PURPOSE: To test the null hypothesis that there is no difference in patient-reported and objective outcomes of revision ligament reconstruction and tendon interposition (LRTI) compared with primary LRTI. METHODS: This case-control investigation enrolled 10 patients who had undergone revision LRTI at a tertiary care center. All patients had previously undergone primary trapeziectomy with LRTI. Patients with a minimum of 2 years' follow-up were eligible. All patients completed an in-office study evaluation...
December 2016: Journal of Hand Surgery
Kim R Spekreijse, Ruud W Selles, Muhammed A Kedilioglu, Harm P Slijper, Reinier Feitz, Steven E Hovius, Guus M Vermeulen
PURPOSE: To compare the long-term outcomes of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) with trapeziometacarpal arthrodesis for osteoarthritis (OA) of the basal thumb joint. METHODS: Patients were evaluated for pain, daily functioning, strength, and complications after a mean follow-up of 5.3 years. Generalized estimating equations statistics were used to compare repeated measurements over time in both groups. RESULTS: After 5 years, patients who had trapeziectomy with LRTI had significantly better pain reduction and function than the arthrodesis group...
September 2016: Journal of Hand Surgery
Aparajit Naram, Keith Lyons, Douglas M Rothkopf, Edward R Calkins, Thomas Breen, Marci Jones, John V Shufflebarger
BACKGROUND: In the treatment of basal joint arthritis of the thumb, recent studies suggest equivalent outcomes with regard to long-term pain, mobility, and strength, in patients undergoing either trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). The goal of this study was to investigate risk factors for complications in carpometacarpal (CMC) arthroplasty. METHODS: We conducted a retrospective chart review of 5 surgeons at a single institution performing CMC arthroplasties from November 2006 to November 2012...
March 2016: Hand: Official Journal of the American Association for Hand Surgery
Elham Mahmoudi, Frank Yuan, Meghan E Lark, Oluseyi Aliu, Kevin C Chung
BACKGROUND: Despite equivalent outcomes among surgical treatments of thumb carpometacarpal arthritis, little is known about the variation in spending. Because of its complexities, the authors hypothesized that trapeziectomy with ligament reconstruction and tendon interposition incurs the greatest cost to Medicare compared with other surgical procedures. METHODS: Using a random 5 percent sample of Medicare beneficiaries diagnosed with thumb carpometacarpal joint arthritis, the authors examined total and out-of-pocket spending for 3530 patients who underwent a surgical treatment between 2001 and 2010...
June 2016: Plastic and Reconstructive Surgery
Jean-David Werthel, Thierry Dubert
UNLABELLED: Recent studies seem to show that ligament reconstruction with tendon interposition (LRTI) does not provide any benefit over trapezium excision alone; however dorsal subluxation was not measured in these studies. We believe it is logical to perform ligamentoplasty in order to obtain long-term stability and therefore treat dorsal subluxation. Our aim is to verify this hypothesis in an observational prospective study of LRTI using the entire flexor carpi radialis (FCR) tendon...
April 2016: Hand Surgery and Rehabilitation
H Lenoir, A Erbland, D Lumens, B Coulet, M Chammas
Total trapeziometacarpal (TMC) joint replacement is increasingly being performed for the treatment of basal joint arthritis. However, complications such as instability or loosening are also frequent with TMC ball-and-socket joint replacement. Management of these complications lacks consensus. The purpose of this study was to report the results of 12 cases of failed TMC joint replacement that were treated by trapeziectomy with ligament reconstruction and tendon interposition (LRTI) arthroplasty. The follow-up consisted of functional (numerical scale, DASH score, satisfaction), physical (range of motion, strength) and radiological (Barron and Eaton ratio measurement) assessments...
February 2016: Hand Surgery and Rehabilitation
Letizia Marenghi, Marco Paterlini, Silvio Tocco, Maurizio Corradi
The original Burton-Pellegrini technique used to treat trapeziometacarpal joint osteoarthritis suggests the use of half of the flexor carpi radialis (FCR) width to reconstruct the ligament and perform the tendon interposition arthroplasty. In our study, unlike the original technique, we used the full thickness of the FCR and evaluated a sample of 100 thumbs (95 patients) preoperatively and postoperatively, with a mean follow-up of 36 months. According to the Eaton classification, 1 thumb was grade II, 81 were grade III, and 18 were grade IV...
June 2016: Techniques in Hand & Upper Extremity Surgery
Shuji Taketomi, Hiroshi Inui, Kensuke Nakamura, Ryota Yamagami, Keitaro Tahara, Takaki Sanada, Hironari Masuda, Sakae Tanaka, Takumi Nakagawa
PURPOSE: the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. METHODS: thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study...
July 2015: Joints
Alexander W Hooke, Joshua Alan Parry, Sanjeev Kakar
PURPOSE: To test the biomechanical stability of ligament reconstruction and tendon interposition (LRTI) compared with Mini TightRope fixation for thumb metacarpal subsidence after trapeziectomy. METHODS: Fifteen fresh human cadaveric hands underwent trapeziectomy and were divided into 3 treatment groups: LRTI using a biotenodesis screw and single versus dual Mini TightRope fixation. The thumb and index fingers were removed distal to the metacarpal; the distal ends of the metacarpals and proximal radius were potted in urethane resin and mounted onto a servohydraulic testing machine...
March 2016: Journal of Hand Surgery
L Reissner, M Marks, S Schindele, D B Herren
UNLABELLED: The aim of our study was to investigate if pre- and postoperative radiographic thumb carpometacarpal position is correlated with clinical and subjective outcomes. Radiographs of 105 patients undergoing trapeziectomy with ligament reconstruction and tendon interposition were analysed before, as well as 1 year after, surgery for dorsal subluxation and proximal migration of the thumb metacarpal bone. Furthermore, key pinch strength was measured and patients completed the Michigan Hand Outcomes Questionnaire...
March 2016: Journal of Hand Surgery, European Volume
Kim R Spekreijse, Guus M Vermeulen, Muhammed A Kedilioglu, Harm P Slijper, Reinier Feitz, Steven E Hovius, Ruud W Selles
PURPOSE: To compare in trapeziometacarpal (TMC) osteoarthritis the effects of trapeziectomy with tendon interposition and ligament reconstruction (LRTI) with or without a bone tunnel after a mean follow-up of 5 years. METHODS: We randomized 79 women (aged 40 years or older) with stage IV TMC osteoarthritis to either trapeziectomy with LRTI using a bone tunnel (Burton-Pellegrini) or a tendon sling arthroplasty (Weilby). Before surgery and at 3 months and 1 year after surgery, patients were evaluated for pain, function, strength, satisfaction, and complications...
November 2015: Journal of Hand Surgery
Mustafa Javed, Tarek Nazar, Andrew M Collier
BACKGROUND: Various surgical options used in the treatment of osteoarthritis of the basal joint of the thumb that are refractory to non-surgical management. This study was conducted to provide short term functional outcomes using the mentioned technique in treating basal joint arthritis of the thumb. METHODS: We treated basal joint arthritis of the thumb by trapeziumectomy and volar oblique ligament reconstruction using flexor carpi radialis tendon and "suspension" interposition arthroplasty using the entire tendon split along its length and tied as a double knot at the base of the thumb metacarpal...
January 2015: Journal of Ayub Medical College, Abbottabad: JAMC
Richard A Bernstein
Osteoarthritis of the hand continues to be a problem in an aging population and affects the proximal and distal interphalangeal, metacarpophalangeal, and carpometacarpal joints in the hands. Heberden nodes develop in the distal interphalangeal joints and typically present as a deformed and enlarged joint and can cause pain. Surgery rarely is necessary because functional difficulties are uncommon; however, there may be problems if the metacarpophalangeal and proximal interphalangeal joints are involved because cartilage destruction generates pain and causes weakness and motion loss...
2015: Instructional Course Lectures
Anne Wajon, Toby Vinycomb, Emma Carr, Ian Edmunds, Louise Ada
BACKGROUND: Surgery is used to treat persistent pain and dysfunction at the base of the thumb when conservative management, such as splinting, or medical management, such as oral analgesics, is no longer adequate in reducing disability and pain. This is an update of a Cochrane Review first published in 2005. OBJECTIVES: To assess the effects of different surgical techniques for trapeziometacarpal (thumb) osteoarthritis. SEARCH METHODS: We searched the following sources up to 08 August 2013: CENTRAL (The Cochrane Library 2013, Issue 8), MEDLINE (1950 to August 2013), EMBASE (1974 to August 2013), CINAHL (1982 to August 2013), Clinicaltrials...
2015: Cochrane Database of Systematic Reviews
Andrew Harston, Yorell Manon-Matos, Selena McGill, Rebecca Jones, Joris Duerinckx, Thomas W Wolff
INTRODUCTION: Osteoarthritis of the trapeziometacarpal joint, also known as the thumb carpometacarpal joint, is one of the most common anatomic sites of arthritis in the human body. Many surgical techniques to address this problem have been developed; including, trapeziectomy with or without ligament reconstruction tendon interposition, implant arthroplasty, and arthrodesis. No methods have yet proven superior to the others, and each has associated limitations and complications. The primary complication found in the literature after arthrodesis of the trapeziometacarpal joint is nonunion; with a reported incidence in the literature as 13% (8% to 39%)...
March 2015: Techniques in Hand & Upper Extremity Surgery
Gilles Berrut
Osteoarthritis of the base of the thumb is a common and painful condition, mostly observed in post menopausal women. This paper proposes a critical review of the recent papers in the point of view of geriatric medicine. The basal joint of the thumb is formed by the trapeziometacarpal joint and the carpometacarpal joint of the thumb. The trapeziometacarpal joint is a saddle joint with a wide mobility. The trapezium is most important bone which authorizes movement of rotation towards every finger of the hand...
December 2014: Gériatrie et Psychologie Neuropsychiatrie du Vieillissement
Ali Erşen, Mehmet Demirhan, Ata Can Atalar, Ahmet Salduz, Onur Tunalı
OBJECTIVE: The aim of this study was to evaluate the long-term radiological and functional results of distraction interposition arthroplasty using an Achilles tendon allograft. METHODS: The study included 5 patients (3 females and 2 males; mean age: 31 years, range: 25 to 41 years) who underwent distraction interposition arthroplasty for stiff elbow and arthrosis due to intrinsic factors between 2001 and 2010. Interposition with fresh-frozen Achilles allograft and collateral ligament reconstruction were performed in all patients...
2014: Acta Orthopaedica et Traumatologica Turcica
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