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Arthrose trapèzo-métacarpienne : hémi-trapèzectomie arthroscopique par un abord thénarien - 10/06/21

Trapeziometacarpal osteoarthritis: Arthroscopic hemitrapeziectomy using the thenar portal

Doi : 10.1016/j.rcot.2020.12.001 
Agustin Guillermo Donndorff , Ignacio Rellan, Gerardo Luis Gallucci, Jorge Guillermo Boretto, Ezequiel Ernesto Zaidenberg, Pablo De Carli
 Department of Orthopaedics, Italian Hospital of Buenos Aires, Potosí 4215, C1199ACK, Buenos Aires, Argentine 

Auteur correspondant.
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 10 June 2021

Abstract

Background

Although the standard 1Radial and 1Ulnar portals allow for visualization of most of the trapezium articular surface, the proximity of these two portals can often make arthroscopic triangulation and visualization of the most lateral capsule and joint surface challenging. Despite its already reported advantages in improving visualization, there is little literature reporting the clinical experience with the Thenar Portal. The purpose of this study is to describe potential complications and the short-term clinical-radiographic outcomes of arthroscopic hemitrapeziectomy using the Thenar Portal in order to determine its safety and efficacy as a standard working portal.

Patients and methods

A retrospective chart review was conducted for all patients diagnosed with first carpometacarpal (CMC) osteoarthritis who were treated surgically with an arthroscopic hemitrapeziectomy. Only patients with stage II or III osteoarthritis and a minimum of 1-year follow-up were included. Twenty-two patients (24 thumbs) with an average age of 62 years met the inclusion criteria. The average follow-up was 52 months. Intraoperative and postsurgical complications were recorded. Objective evaluation consisted of an assessment of range of motion (ROM), grip and pinch strength. Subjective evaluation consisted of a DASH questionnaire and the visual analog scale to score pain at rest, during activities, and function.

Results

There were no intra- or post-surgical complications. In 1 case, pain persisted with a poor functional result, requiring a revision surgery. Average range of motion (compared with the contralateral) showed a statistically significant improvement in palmar abduction and radial abduction of the CMC joint: 50° vs. 55° (p=0.01235), and 50° vs. 55° (p=0.06009), respectively. There was no statistically significant improvement in thumb adduction, grip strength, or lateral and tip-pinch. All patients achieved retropulsion with their affected thumb. According to the VAS, average rest pain improved from 7.5 to 0 (p<0.001) and from 9 to 0 (p<0.001) during activity. The average final function and QuickDASH were 9 (VAS) and 8, respectively (p<0.001). The average radiographic proximal migration of the first metacarpal was 2.9mm (range: 0.7–5.8mm).

Discussion

Arthroscopic hemitrapeziectomy using the Thenar portal: (1) improved visualization of the trapeziometacarpal joint, (2) facilitated arthroscopic triangulation, and (3) represents a safe and effective alternative for the treatment of thumb osteoarthritis, with pain relief and function improvement in most patients without a higher risk of complications.

Level of evidence

IV.

Le texte complet de cet article est disponible en PDF.

Keywords : Osteoarthritis/surgery, Postoperative complications, Thumb/surgery, Arthroscopy/methods, Carpometacarpal Joints/surgery



 Cet article peut être consulté in extenso dans la version anglaise de la revue Orthopaedics & Traumatology: Surgery & Research sur Science Direct (sciencedirect.com) en utilisant le DOI ci-dessus.


© 2020  Elsevier Masson SAS. Tous droits réservés.
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