The current benchmark for the treatment of Eaton stage I disease of the trapeziometacarpal (TMC) joint includes palmar oblique ligament reconstruction and reflects its primary role in providing stability during lateral pinch. This study prospectively evaluates the efficacy of an alternative extra-articular approach using a 30° extension osteotomy of the thumb metacarpal to redistribute trapeziometacarpal contact area and load, obviating the need for ligament reconstruction. Preoperative and postoperative subjective and objective data are reported for 12 patients enrolled in the study between 1995 and 1998. Trapeziometacarpal arthrotomy allowed accurate intra-articular assessment and verified palmar oblique ligament incompetence in each case. The average follow-up period was 2.1 years (range, 6-46 months). All osteotomies healed at an average of 7 weeks. Eleven patients were satisfied with outcome. Grip and pinch strength increased an average of 8.5 and 3.0 kg, respectively. Thumb metacarpal extension osteotomy is an effective biomechanical alternative to ligament reconstruction in the treatment of Eaton stage I disease of the trapeziometacarpal joint. (J Hand Surg 2000;25A:1100-1106. Copyright © 2000 by the American Society for Surgery of the Hand.)
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- Pathobiology of articular cartilage in trapeziometacarpal osteoarthritis. I. Regional biochemical analysis.J Hand Surg. 1994; 19A: 70-78
- Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint.J Hand Surg. 1991; 16A: 967-974
- Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. II. Articular wear patterns in the osteoarthritic joint.J Hand Surg. 1991; 16A: 975-982
- Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament.J Hand Surg. 1993; 18A: 238-244
- Anatomy of trapeziometacarpal ligaments.J Hand Surg. 1993; 18A: 226-231
- Arthroplasty of the basal joint of the thumb: long-term follow-up after ligament reconstruction with tendon interposition.J Bone Joint Surg. 1995; 77A: 346-355
- Ligament reconstruction for the painful thumb carpometacarpal joint.J Bone Joint Surg. 1973; 55A: 1655-1666
- Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment.J Hand Surg. 1984; 9A: 692-699
- Long-term results of volar ligament reconstruction for symptomatic basal joint laxity.J Hand Surg. 2000; 25A: 297-304
- Histopathology of the palmar beak ligament in trapeziometacarpal osteoarthritis.J Hand Surg. 1999; 24A: 496-504
- Osteotomy for trapeziometacarpal arthrosis: 4 (1-6) year follow-up in 12 cases.Acta Orthop Scand. 1992; 63: 462-464
- First metacarpal osteotomy for carpometacarpal osteoarthritis.J Hand Surg. 1991; 16B: 424-427
- Osteotomy in the treatment of osteoarthritis of the first carpometacarpal joint.J Bone Joint Surg. 1983; 65B: 179-181
- Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis: a biomechanical study.J Hand Surg. 1996; 21A: 16-23
- Outcomes of hand surgery.J Hand Surg. 1995; 20B: 841-855
- Biomechanical analysis of static forces in the thumb during hand function.J Bone Joint Surg. 1977; 59A: 27-36
- Kinematics of the normal trapeziometacarpal joint.J Orthop Res. 1994; 12: 197-204
- Extension metacarpal osteotomy in the treatment of trapeziometacarpal osteoarthritis.Atlas Hand Clin. 1997; 2: 183-202
Accepted: June 20, 2000
Received: February 1, 2000
*No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject fo this article.
**Reprint requests: Matthew M. Tomaino, MD, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, 3471 Fifth Ave, Suite 1010, Pittsburgh, PA 15213.
© 2000 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.