Addition-Subtraction Osteotomy With Ligamentoplasty for Symptomatic Trapezial Dysplasia With Metacarpal Instability

PURPOSE: Symptomatic trapezial dysplasia with metacarpal instability in a nonarthritic joint can lead to a disabling condition characterized by decreased pain, mobility, and strength. Bony correction may be required in dysplastic joints, because soft tissue correction might be insufficient to stabilize the trapeziometacarpal (TMC) joint. We combined 2 techniques described previously, an abduction-extension osteotomy of the first metacarpal and an opening wedge osteotomy of the trapezium, including a ligament reconstruction (hemi-flexor carpi radialis). The aim of this study was to investigate the long-term results of this technique.

METHODS: In this single-center, retrospective cohort study, we included patients treated surgically for primary instability of the TMC joint with trapezial dysplasia between 2003 and 2007. We measured pain (visual analog scale), mobility (opposition and retropulsion), patient-reported disability (Quick-Disabilities of the Arm, Shoulder, and Hand), and radiographic evaluation (Devers' angle) 10 years after surgery. Results were compared with preoperative data.

RESULTS: We reviewed 17 thumbs retrospectively (mean follow-up, 12 years). One patient was converted to a TMC prosthesis. Key pinch improved significantly from 5.2 kg (±2.4 kg) at baseline to 6.3 kg (±2.1 kg) at 10-year follow-up. Quick-Disabilities of the Arm, Shoulder, and Hand score and Devers' angle were significantly better after 10 years compared with preoperative data. There was a mean visual analog scale score of 0.5 (±1.4) at rest and 2.3 (±2.6) during activities. Ten years after surgery, 5 patients had a stable Eaton score of 1. Four patients had progression to stage 2, and 5 to stage 3.

CONCLUSIONS: Addition-subtraction osteotomy with ligamentoplasty has a positive long-term effect on symptomatic trapezial dysplasia with TMC joint instability. Although this operation did not protect the TMC joint from further wear, pain was acceptable for most patients.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.