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This study aimed to evaluate the effect of bone marrow aspirate concentrate (BMAC) in the treatment of osteoarthritis of the thumb first carpometacarpal joint. Injections were carried out in 27 thumbs. According to the Dell classification, there were 2 stage I, 11 stage II, 13 stage III and 1 stage IV cases. The bone marrow was aspirated from the iliac crest, concentrated by centrifugation, and injected under fluoroscopic control into the pathological thumb. Results were assessed at a mean 16 months' follow-up (range, 8-26). Clinical evaluation comprised QuickDASH and PRWE scores, pain at rest on a numerical analog scale (NAS), and thumb column abduction on goniometry. QuickDASH and PRWE scores were 59 (range, 27-82) and 88 range, 37-125) preoperatively and 29 (range, 0-64) and 50 (range, 1-99) postoperatively, respectively. Mean pain at rest on NAS improved from 7 (range, 1-10) to 4 (range, 0-9). Thumb abduction improved by a mean 18° over preoperative data. No postoperative complications were found. Two patients had to be operated on for inefficacy of injection. This is the first article presenting the effect of an intra-articular injection of BMAC in the thumb first carpometacarpal joint and the results were encouraging. Many patients showed improved quality of life and pain relief. These injections appear to be an effective means of postponing surgery., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The RegJoint™, a bioabsorbable polylactide scaffold, was introduced in 2011 for scaphometacarpal interposition following trapeziectomy for osteoarthritis. As previous clinical trials provided controversial results, we aimed to prove the non-inferiority of RegJoint™ interposition. In this retrospective study, first metacarpal suspension arthroplasty alone (SA) was compared to suspension with RegJoint™ interposition (RJ). Thirty-four patients with 37 treated thumbs (SA: 14; RJ: 23) were assessed clinically and radiologically at a mean follow-up of 5.3 ± 2.6 years (SA: 7.96; RJ: 3.73). Patient-reported outcomes were measured on three questionnaires (DASH, PRWE and PEM) and a visual analogue pain scale; there were no significant differences between the 2 groups. Clinical assessment comprised range of motion, opposition, pain, first-ray length, hand span, prominence, instability, force and sensitivity to touch. The RJ group showed significantly better palmar abduction (p = 0.026); the other outcome parameters were comparable in the 2 groups. Follow-up radiographs showed osteolysis in 2 SA hands and 3 RJ hands (p = 0.551). First-ray length had decreased by a mean 4.7 ± 2.7 mm at follow-up (SA: -3.8; RJ: -5.2; p = 0.056). No signs of adverse tissue reactions were observed. We conclude that RegJoint™ spacers do not produce more complications than suspension alone but provide no added benefit., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

We compared the clinical outcomes of post-trapeziectomy protocols according to their duration. The main hypothesis was that there would be no significant difference in postoperative function whether immobilization duration was 2 or 4 weeks. The secondary hypotheses were that there would be no significant difference in postoperative pain, motion, or strength. 40 trapeziectomies were reviewed. Two weeks' postoperative commissural immobilization was systematic. Patients were then divided in two groups. For the first 20 patients (group I), immobilization stopped at 2 weeks. For the next 20 patients (group II) it was replaced by a splint for further 2 weeks. We compared mean pre- and post-operative (10-20 weeks) function (QuickDASH score), pain (visual analog scale - VAS), thumb opposition (Kapandji score) and strength (palmar pinch test) between the two groups. There was no significant difference between groups in postoperative values or in pre- to post-operative progression. The main hypothesis was confirmed: there was no significant difference in the postoperative function whether the immobilization was for 2 or 4 weeks. The secondary hypotheses regarding postoperative pain, motion and strength were also confirmed., (Copyright © 2021. Published by Elsevier Masson SAS.)

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Copyright of Strahlentherapie und Onkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The double oblique osteotomy with rotation of the trapeziometacarpal (TMC) joint procedure (DOOR procedure) is a surgical technique conceived to treat non-traumatic TMC instability, often responsible for TMC joint osteoarthritis. The main goal of this procedure is to correct the exaggerated slope of the trapezium. It also allows opening of the first web space, transfers pressure to healthy cartilage areas, and reverses the forces exerted on the trapeziometacarpal ligaments. The technique is demanding and should be learned in the anatomy laboratory. Since 2000, we have carried out 96 cases, evidence that this technique is reliable. Our case series consists of 88 patients (71 females, 17 males), with 8 patients operated bilaterally. The average age at the time of the procedure was 48 years. The first 22 operated (24 cases) between 2000 and 2005 were reviewed in 2015 with an average follow-up of 13 years. Pain averaged 0.5 on VAS. The average QuickDASH score was 6. The average mobility according to Kapandji's index was 9 for opposition and 3 for retropulsion. The grip strength compared to that of the contralateral side was 180%, the key pinch strength was 100% of the contralateral side and the tip pinch strength was 98%. This intervention makes up approximately 10% of our surgical indications in thumb basal joint arthritis. It is reserved for young women with early arthritis or unstable thumbs, and for men who perform manual labor. While the results take a long time to achieve (about 3 months), they remain highly satisfactory at the average follow-up of 13 years., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The two approaches most often used for placing implants and trapeziometacarpal prostheses are the laterodorsal approach and the lateropalmar approach. The advantages and disadvantages of these two approaches are set out. Each one allows optimal joint exposure while preserving or repairing the peritrapezial musculotendinous structures. They allow the insertion of partial or total trapeziometacarpal implants and modern coupled trapeziometacarpal prostheses. Each approach must be practiced and mastered on cadaver specimens before being used for trapeziometacarpal surgery., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The numerous surgical techniques proposed for treating thumb basal joint arthritis (osteotomy of the first metacarpal, trapezial osteotomy, simple trapeziectomy, trapeziectomy with implant, total joint prosthesis, arthroplasty by interposition, etc.) necessitate an anatomically based radiological evaluation of the different pathological forms of thumb basal joint arthritis. Here, the author defines three parameters: narrowing of the trapeziometacarpal (TM) joint space: TMA; TM instability and subluxation: TM I; scaphotrapeziotrapezoid damage: STT. Four stages of TM osteoarthritic deterioration are defined: TMA0: no joint narrowing (painful and unstable joint); TMA1: narrowing <50%; TMA2: narrowing>50%; TMA3: disappearance of the joint space, bone erosions. For TM instability/subluxation: TMI 0: reducible subluxation (unstable and painful TM); TMI 1: reducible subluxation but with imperfect reintegration; TMI 2: non-reducible subluxation <1/3; TMI 3: subluxation>1/3. For STT damage, STT 0: radiograph is normal but anatomical damage is visible intraoperatively; STT 1: joint space narrowing <50%; STT 2: joint space is barely visible; STT 3: presence of erosion, sclerosis, irregularities. He outlines the shortcomings of the often-used Dell and Eaton-Littler classifications. A prospective study involving multiple cases having the same anatomical and radiological appearance that are assessed with sufficient follow-up is needed to standardize the modalities of surgical treatment., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Many surgical options have been proposed for the treatment of first carpometacarpal (CMC1) osteoarthritis. Conventional techniques are invasive, so we wanted to develop an arthroscopic technique. Partial trapeziectomy combined with various interpositions and ligament reconstruction is a long-standing intervention. As in total trapeziectomy, the combination with ligament reconstruction remains controversial. The aim of this study was to demonstrate the benefits of adding an abductor pollicis longus (APL) ligament reconstruction to partial trapeziectomy performed under arthroscopy. This study analyzes the results of two consecutive case series carried out by a single surgeon. Thirty-four patients underwent an isolated partial trapeziectomy and 49 patients underwent partial trapeziectomy with ligament reconstruction using the APL. The patients were reviewed with an average follow-up of 3.7 years (13 months to 8.6 years) by an independent observer. The assessment included the analysis of pain, thumb appearance, QuickDASH score, Nelson Hospital score, and measurements of mobility and strength. For all patients, there was a marked reduction in pain (7.13 preoperatively vs.1.37 postoperatively) with 71% of patients having a painless thumb, the Nelson (11.14) and QuickDASH (17.89) scores as well as a clinical improvement in mobility and grip strength (14.5 KgF preop vs. 19.6 KgF postop) and key pinch (4.4 KgF preop vs. 5.4 KgF postop). The mean recovery time was 18.8 weeks. Eighty-four percent of patients were satisfied with the procedure with 90% having a stable thumb. No CRPS was found. However, the results were better for patients who underwent ligament reconstruction. There was a significant gain in grip strength, better first web opening and a lower percentage of painful thumbs. The other items were also slightly improved, but not significantly (Nelson Hospital score, QuickDASH score, key grip strength, percentage of stable thumbs, subjective thumb value estimated by patients). This technique is a less aggressive treatment of CMC1 osteoarthritis, with simplified and rapid rehabilitation. The addition of ligament reconstruction using the APL appears useful. The advantages of arthroscopy are a less painful postoperative course, low morbidity, ligament conservation, along with better access to remove loose bodies, osteophytes and to perform synovectomy. Partial trapeziectomy, which is especially indicated when the scaphotrapeziotrapezoid joint is not symptomatic, is much less used than total trapeziectomy; however, it is an attractive surgical option for young patients with significant functional demands. Arthroscopic partial trapeziectomy is a safe and reliable procedure., (Copyright © 2021. Published by Elsevier Masson SAS.)

Controversy persists around trapeziectomy as standard of care in thumb base osteoarthritis. The difficulty of management of failure requires the utmost caution in choice of the initial technique. We here report a retrospective series of 10 revision procedures following trapeziectomy, supported by a review of literature. The main cause of revision was collapse of the thumb column resulting in arthrogenic contact of the first metacarpal with the scaphoid. At a mean 73.3 months' follow-up, 5 patients had to undergo additional surgery. Mean VAS pain score was 2.9; 5 patients were pain-free. Strength was more severely impaired than joint motion, resulting in disappointing functional results. The present outcomes are consistent with the literature, which mostly comprises heterogeneous series, making it impossible draw conclusions to guide practice. The most common option seems to be to perform a new ligament procedure, with or without tendon or pyrocarbon interposition, and was the one that provided the only good result in the present series. Other techniques (composite graft, non-autogenic interposition, scaphometacarpal prosthesis) seem promising, and deserve large-scale evaluation. Thus, the gold-standard status of trapeziectomy should be weighed against the observation of these multi-operated patients in situations of therapeutic impasse. Should indications for first-line trapeziectomy be restricted, especially in patients with a revision risk factor? LEVEL OF EVIDENCE: 4., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Surgical treatment of thumb basal joint arthritis generally yields good and excellent results. In case of failure, the surgeon will propose an appropriate solution to the patient, one that can be performed easily. Each technique has its own complications: shortening with trapeziometacarpal pain following trapeziectomy, loosening and instability following total arthroplasty, instability for some implants. There are also intolerances such as allergies to nickel, foreign body reactions to silicone and inflammatory reactions to some synthetic ligament implants. It is important to bear these complications in mind when determining the best possible surgical technique initially. The different surgical solutions are exposed here. Prosthetic replacement is preferred in case of loosening when it is technically possible in order to preserve the thumb's length. A conversion to trapeziectomy with or without interposition (implant or ligament reconstruction) will be carried out in the other cases. In case of trapeziectomy failure, solutions are more difficult to find. In the current state of things, it seems that implant or biological tissue interposition is the best solution., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Arthrodesis of the trapeziometacarpal (TMC) joint is one of the first surgical procedures used to treat thumb basal joint arthritis. From 1970 to 1990, we performed 254 TMC arthrodeses with crossed K-wires. From 2015 to 2016, we performed 12 TMC arthrodesis procedures with shape-memory staples. The results were evaluated with De La Caffinière's classification and took into account patient satisfaction and any complications. The results were satisfactory overall, without any significant difference between the two fixation methods but with a rather high complication rate. The indication for arthrodesis in surgical treatment of thumb basal joint arthritis is based on the patient's age and occupation. The best indication is a young active patient., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Basal joint arthroscopy is one of the more recent evolutions of small joint arthroscopy in upper limb surgery. Conventional arthroscopy equipment is generally sufficient to perform these procedures without any specific adaptation. Arthroscopic exploration of the trapeziometacarpal joint is performed through 1R, 1U portals with the addition of a thenar portal in some indications. In the context of basal joint arthritis, we can distinguish diagnostic, preventive and therapeutic indications for arthroscopy. Diagnostic indications are the assessment of painful post-traumatic basal joint lesions of cartilage and ligaments, and the evaluation of chondromalacia and ligament attenuation to help classify basal joint osteoarthritis to provide additional clinical information, which can influence further treatment depending on the stage of the disease. Preventive indications are reduction of Bennett's fracture, basal joint dislocation management to avoid post-traumatic instability and chondromalacia; it can also be indicated after decompensation of hyperlaxity. Therapeutic indications are debridement, ligament augmentation procedures or shrinkage ± interposition ± partial or total trapeziectomy, ligamentoplasty, etc. Basal joint arthroscopy appears to be the seat of advances in arthroscopic procedures with clinical results at least as effective as classical open surgery, but this technique still requires long-term evaluation., (Copyright © 2021. Published by Elsevier Masson SAS.)

Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints., (Copyright © 2021. Published by Elsevier Masson SAS.)

In 1970, Jean-Yves de la Caffinière developed the first trapeziometacarpal (TMC) joint prosthesis, a ball-and-socket design based on hip replacement implants. From 1970 to 1990, the first generation of cemented prostheses was developed. At that time, trapeziectomy, with tendon interposition or suspension arthroplasty, and Swanson silastic spacers remained the most widely used surgical procedures for thumb basal joint arthritis. From 1990 to 2010, a second generation of cementless prostheses was developed. The third generation was introduced after 2010 and consisted of dual mobility prostheses. In 2020, TMC arthroplasty (simple or dual mobility) is a reliable option in thumb basal joint arthritis with an implant survival rate of 90% at 10 years of follow-up, while providing pain relief and restoring strength and mobility. Restoration of the thumb's length corrects most thumb Z-deformities, so the TMC joint prosthesis may be a viable alternative surgical solution to trapeziectomy, which remains the gold standard in English-speaking countries. Moreover, trapeziectomy after failed TMC arthroplasty provides outcomes equivalent to those of primary trapeziectomy., (Copyright © 2021. Published by Elsevier Masson SAS.)

Total trapeziectomy has been extensively studied and has been used to treat thumb basal joint arthritis for decades. It remains a simple and reliable technique that every hand surgeon must learn and master, as a primary or revision procedure. Several techniques have been described, but none of them seems better than the others. Without the need for an implant and because of its long-lasting benefits, total trapeziectomy is currently the only surgical technique for thumb basal joint arthritis that can lay claim to being a potential life-long procedure., (Copyright © 2021. Published by Elsevier Masson SAS.)

The trapeziometacarpal joint (TMC) is a saddle joint that is subjected to tremendous repetitive loads through our lifetime. This joint is apparently congruent, but only a small part of the articular surface is loaded during pinch grips. This design implies a perfect bony anatomy, high quality articular cartilage and no ligament laxity. Under certain circumstances, where these different anatomical variables are imperfect, symptoms and pain can start at a very early stage in life. They are mainly acquired, but can be posttraumatic in origin. High quality radiographic views are needed: these radiographs must be done methodically by well-trained radiologists. The symptoms and radiographic changes may not match, such as when radiographic changes are minimal but functional impairment is significant. The primary goal of treatment is conservative. This cannot be stressed enough since conservative treatment can be successful with good follow-up by the hand surgeon: resting splint, good postures at work and if necessary, anti-inflammatory drugs and paracetamol. If this fails after a minimum of 6 months, different osteotomies can be proposed, combined with ligament augmentation in some cases. These osteotomies are mainly extra-articular, can be at the level of the base of the first metacarpal and the trapezium, or can be solely at the base of the first metacarpal. Isolated osteotomies of the trapezium should be avoided since they tend to close the first web space. In certain posttraumatic cases, intra-articular osteotomy of the malunion can be done to restore congruency and provide pain relief., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Trapeziectomy has been considered as the gold standard for treating trapeziometacarpal arthritis. But trapezial space collapse is responsible for thumb strength decrease and intracarpal deformities (with or without tendon interposition). Partial trapeziectomy with interposition of a chondrocostal autograft combines the advantages of trapeziectomy and a biological spacer without the disadvantages of arthroplasty. Partial trapeziectomy is performed by a dorsal approach, under regional anaesthesia. The graft is harvested by a direct approach of the 9th rib during a short bout of general anaesthesia and inserted in the trapeziectomy space. A thumb spica cast is used for 3-6 weeks. In our experience, long-term outcomes and radiological evolution of the graft are good, similar to that of other procedures reported in the literature, except for strength, which is better in this scenario. With more than 5 years of follow-up, the graft is viable, the length of the thumb is maintained, and any areas of graft metaplasia are localized. The result is stable over time and any donor site morbidity is anecdotal. The interposition of a biological material is feasible and produces a stable and strong thumb., (Copyright © 2021. Published by Elsevier Masson SAS.)

Trapeziometacarpal joint ligament reconstruction is a surgical option in the early stages of thumb basal joint arthritis when the joint is painful and unstable without chondropathy. Arthroscopy is invaluable here to ensuring the joint surfaces are intact, which is often underestimated by radiography. The Eaton-Littler procedure using a distally pedicled flexor carpi radialis slip has been studied the most in this context. This reconstruction provides pain relief while slowing the rapid development of osteoarthritis., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Thumb metacarpophalangeal instability is commonly found in conjunction with trapeziometacarpal osteoarthritis. If not corrected, it can have detrimental effects on the outcome. The authors describe the two types of metacarpophalangeal deformities - hyperextension and valgus - their pathophysiology and the surgical repair techniques available to surgeons. An algorithm for treating this instability is presented., (Copyright © 2020. Published by Elsevier Masson SAS.)

Degenerative thumb carpometacarpal (CMC) joint osteoarthritis is a common disease in women starting at 40-50 years of age. Nevertheless, synovitis and initial cartilage damage start earlier, and then degenerative arthritis develops leading to joint narrowing with progressive exposure of subchondral bone, subluxation, osteophyte formation and joint deformity that can impact the surrounding joints. The aim of this study was to evaluate the outcome of patients treated with autologous chondrocyte transplantation at the thumb CMC joint at early stages. A prospective study on 10 cases of thumb CMC osteoarthritis in 8 patients was done. The thumbs were stage Eaton II (2 cases) and III (8 cases) and were treated by CMC arthroplasty with the implant of autologous chondrocytes by an open or arthroscopic technique. Two patients were treated bilaterally. Preoperatively all patients had persistent pain resistant to various kinds of nonoperative treatments for at least 1 year. Mean preoperative pinch strength was 3.7 Kg pain on VAS was 8, DASH was 55. All patients had limited abduction and flexion at the end range. Ethics committee approval was obtained for this study. Fragments of 3-4 mm of cartilage were harvested by arthroscopy or by an open technique from the wrist or elbow joint. Cartilage cells were sent to the laboratory to be grown on a collagenous biphasic matrix (MACI/Novocart®). After 3 weeks, the chondrocyte augmented scaffold was ready to be implanted in the thumb CMC joint, or frozen for a second operation later. All patients were females aged 42-67 years (mean 52 years). The dominant hand was treated in 6 cases. In 7 cases, the patients were operated with an open technique and in three cases by arthroscopy. Partial trapezium resection and dorsoradial ligament reconstruction was added to stabilize the CMC joint in most cases. Patients were seen in person at 1, 3, and 6, months, 1 year, 2 years, and 5 years after the initial surgery. Patients (nine thumbs) were then reviewed at a mean follow up 8 years (range 4.4-11 years); pain on VAS, Mayo, DASH and PRWE scores were evaluated at follow-up. One patient was lost to follow-up after 2 years. Of those nine hands, seven had an excellent result according to Mayo score, one had a good result. One thumb CMC joint was still painful and was reoperated and converted to arthroplasty after 4.4 years. All patients regained full range of motion. Mean pinch strength increased to 6.25 ± 1.3 Kg, mean DASH score was 7.3 ± 6.7; pain on VAS was 1.0 ± 1.5; these data were statistically significant compared to preoperative values (p < 0.01). Grip strength also increased in all cases, but this was not statistically significant. PRWE was 7.7 ± 6.4. No complications occurred postoperatively. The results obtained are encouraging since the implanted cartilage has lasted a mean of 8 years and up to 11 years. Biological tissue engineering techniques are being developed and could be a new solution to restore normal cartilage in young patients to postpone more aggressive surgical procedures until an older age. In cases of CMC joint instability, a ligament stabilization procedure was added to avoid subsequent damage to the implanted neocartilage. A longer follow-up and a greater number of cases are necessary to definitively establish the usefulness of this procedure, which has the advantage of being completely biological but the disadvantage of being costly., (Copyright © 2021. Published by Elsevier Masson SAS.)

Although the simultaneous occurrence of arthritis of the wrist and the base of the thumb is rare, it is nonetheless imperative to carry out a preoperative clinical and radiological assessment of the wrist when managing trapeziometacarpal osteoarthritis. The presence of pre-arthritic lesions or established wrist arthritis, even if treated, must be taken into consideration when treating osteoarthritis at the base of the thumb. The coexistence of these lesions determines the entire surgical strategy. Failure to take them into account during the surgical treatment often results in a compromised postoperative course and it often adversely impacts the outcome of secondary surgeries., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Our aim was to explore the different indications of the Mini TightRope® suture button whether during first-line treatment or secondary surgery of thumb carpometacarpal osteoarthritis (OA). The indications for this new device are presented and discussed based on our own small case series and published data. Twenty-one patients treated with the Mini TightRope® were included in a prospective study. One of them was operated on both sides. Fourteen devices were used in first intention for Eaton stage IV OA; the patients underwent trapeziectomy and suture button suspensioplasty only. Four cases consisted of revision surgery for painful proximalization of the first metacarpal after trapeziectomy and ligamentoplasty. Four cases consisted of secondary surgery after trapeziectomy and implant interposition (two silicone implants and two pyrocarbon implants). We captured the demographic data, follow-up time, pain level, pinch strength before and after surgery, range of motion, metacarpal subsidence, and postoperative complications. The average age of the patients was 60 years. There were 19 women and 2 men. The average follow-up time was 2.5 years (1-4). The average pain level, according to a visual analog scale (1-10) was 3.5 (2-5) preoperatively and 2 (1-4) postoperatively at rest and 7 (6-8) preoperatively and 4 (3-6) postoperatively with maximum load. The mean Kapandji score was 9 (7-10) and the retropulsion score was 3 (1-4). The average key pinch and tip pinch strengths were 80% and 78% of the contralateral side at the final follow-up. The trapeziectomy-suspensioplasty group had greater average trapezial space height compared to the revision surgery group (7.0 mm vs. 4.5 mm). There are several indications for the Mini TightRope® device in the treatment of severe thumb carpometacarpal OA: first metacarpal suspension during open or arthroscopic total or partial trapeziectomy and secondary surgery after failure of trapeziectomy with or without implant interposition. The advantage of this new device, which suspends the first metacarpal off the second metacarpal, is the very short immobilization period contrary to other suspensioplasty procedures., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Anatomical variations in the distal insertion of the abductor pollicis longus (APL) muscle onto the 1st metacarpal bone and around the 1st carpometacarpal joint led Eduardo Zancolli to introduce a surgical yet conservative partial APL tenotomy targeting its accessory or supernumerary distal bundles. Following an anatomical and pathophysiological review, we will describe the surgical technique for this minimally invasive extra-capsular procedure. Results and operative indications of this very simple technique are reported as well, which can be performed in Dell stage I or II of trapeziometacarpal osteoarthritis when well-conducted conservative medical treatment has failed to achieve pain relief., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Trapeziometacarpal joint arthrodesis is a surgical option for osteoarthritis of the first carpometacarpal joint; however, it has well-known disadvantages such as non-union and reduced mobility. Revision procedures are often not discussed and lack consensus. We are reporting two cases of satisfactory thumb implant arthroplasty for failed trapeziometacarpal joint arthrodesis in order to discuss the surgical technique, its advantages compared with other surgical options and therefore its potential indications., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Ligament reconstruction and tendon interposition (LRTI) procedures for trapeziometacarpal osteoarthritis aim to prevent proximal metacarpal migration to improve thumb function. We sought to evaluate the effect of the remaining trapezial space on outcomes after trapeziectomy with LRTI. Forty-seven patients were included in this study. Patients were evaluated clinically and radiologically. They were divided into two groups according to the remaining trapezial space at last follow-up. Postoperative to preoperative trapezial space ratio was >50% in group 1 and <50% in group 2. Mean follow-up was 30.8 months. Mean age, sex, dominant side, preoperative stage, and follow-up were similar in both groups. The mean QuickDASH scores were significantly better in group 1 than group 2. Mean tip and key pinch were significantly stronger in group 1, than group 2. Trapeziectomy with LRTI is the most used surgical technique and it produces satisfactory results. Improved clinical outcomes can be achieved when more than 50% of the preoperative trapezial space remains., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Abstract: A spontaneous rupture of the extensor pollicis longus (EPL) tendon occurred in a patient with trapeziometacarpal arthritis. We hypothesize that a mechanical attrition by protrusion at the trapeziometacarpal joint alone was responsible of a spontaneous rupture of the extensor pollicis longus tendon. [Copyright &y& Elsevier]

Abstract: Introduction. – In the surgical treatment of osteoarthritis of the basal joint of the thumb, several options are available. The carpometacarpal arthrodesis should provide stability, strength and resolution of pain. There is however some controversy on the outcome. Materials and methods. – In a retrospective study we reviewed 34 carpometacarpal joint fusions (26 men, eight women; mean age 48 years). Two techniques of fixation have been used: staples (16x) and K-wires (18x). The follow-up was 5.2 years. Results. – The nonunion rate was 39%. Only 60% of the patients was satisfied. The DASH score was 32 (standard deviation 18). Key pinch force was reduced with 27% of the opposite side. Range of motion was slightly reduced: 6° in the interphalangeal joint, 19° in the metacarpophalangeal joint. When fusion was obtained patients’ satisfaction increased to 88%. Conclusion. – Patient satisfaction was low and nonunion rate was high. Better results are obtained in cases with osseous union. More solid fixations, perhaps with addition of bone grafts have to be considered. [Copyright &y& Elsevier]

Trapeziometacarpal instability is a well-known condition that could lead to trapeziometacarpal osteoarthritis. With the focus in the literature being on ligament insufficiency, bony deformity has received much less attention. Although trapezial tilt is currently used to measure trapezial dysplasia, we believe trapezial inclination is a more reliable measurement. The purpose of this study is to compare these two methods for evaluating trapezial dysplasia and to define the most reproducible measurement. Fifty patients were identified who had three consecutive radiographs of the trapeziometacarpal joint. Eaton views with little to no signs of osteoarthritis (Eaton stage I or II) were used. Both trapezial tilt and trapezial inclination were measured by two independent observers on three radiographs for every patient. Intra-observer variation, absolute agreement and consistency, and intra-observer variation and consistency were assessed for both measurements. Mean trapezial tilt was 135° and mean trapezial inclination was 10°. For both observers, intra-observer variation of trapezial inclination was significantly less than for trapezial tilt. Our study shows that mean trapezial inclination in a middle-aged adult population is approximately 10°. This measurement is more reproducible than the more frequently used trapezial tilt and may be a better parameter to define trapezial dysplasia and to guide its treatment., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Many surgical procedures are available for treating trapeziometacarpal (TMC) osteoarthritis (OA). The aim of this study was to analyze the mid- to long-term outcomes of 103 pyrocarbon interposition arthroplasties in the TMC joint with Pyrocardan® implant performed prospectively in a single center to treat painful early stage OA. There were 96 patients with a median age of 59 years. Twenty-eight percent of patients were manual workers and 39% had a fixed dislocation of the first metacarpal. Fifteen percent of patients were 50 years old or more. After a minimum follow-up of 5 years, there was a marked improvement in the pain level (0.6/10), QuickDASH (9/100) and PRWHE (4/100) scores and strength (key pinch 8kg, grip strength 27kg). There were no differences in strength or range of motion compared to the opposite side. Four patients underwent revision surgeries. Two of them were converted to trapeziectomy. The 5-year implant survival rate was 96.2%. Dislocation of the first metacarpal was completely corrected in 80% of cases. Younger patients (≤50 years old) had slightly better outcomes than older ones. Overall satisfaction rate was 96%. Pyrocardan® interposition implant arthroplasty is a reliable alternative to trapeziectomy, total arthroplasty or fusion of the TMC joint especially for young, active patients., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The trapeziometacarpal prosthesis is mostly used in Europe to treat osteoarthritis of the basal joint of the thumb. Its supposed benefits are that it restores the length of the thumb, improves strength, function and mobility while reducing recovery time compared to other surgical treatments. However, previous reviews of the literature could not confirm these assumptions. This article provides an updated systematic review to help answer to these questions through a methodical statistical analysis and to quantify the two main complications, namely failure and deep infection. To achieve these aims, a selection of articles including implant case series was done in the Medline database based on specific criteria. Data about pain, function, strength, infection, and failure were compiled and a statistical analysis was performed. Results show a fast recovery in terms of pain and function but the positive effect on strength seems limited. The failure rate represented by the revision rate is high and the deep infection rate is fairly low. Randomized controlled studies are needed to obtain reliable data to compare the prosthesis to other surgical treatments., (Copyright © 2020 SFCM. Published by Elsevier Masson SAS. All rights reserved.)