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Chirurgie de la main
Volume 34, n° 6
pages 307-311 (décembre 2015)
Doi : 10.1016/j.main.2015.08.005
Received : 3 July 2015 ;  accepted : 28 August 2015
Arthroscopic interposition in thumb carpometacarpal osteoarthritis: A series of 26 cases
Interposition sous arthroscopie dans la rhizarthrose du pouce : à propos d’une série de 26 cas
 

A. Pereira a, S. Ichihara a, b, S. Facca a, S. Hendriks a, S. Gouzou a, P. Liverneaux a,
a Department of Hand Surgery, SOS Main, CCOM, University Hospital of Strasbourg, FMTS, University of Strasbourg, CNRS Icube 7357, 10, avenue Baumann, 67403 Illkirch cedex, France 
b Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan 

Corresponding author.
Abstract

In 2011, we reported good results after a mean follow-up of 14months for a series of 25 patients who underwent thumb carpometacarpal osteoarthritis surgery in which a poly-L-lactic acid implant was interposed arthroscopically. The aim of this study was to evaluate the outcomes after a longer follow-up. The new series consisted of 26 patients, whose average age was 60years, operated with arthroscopy for the interposition of an implant made of poly-L-lactic acid in 12 cases and tendon interposition in 14 cases. After an average follow-up of 20months, the pain assessed with a visual analog scale was on average 6.61/10 before surgery and 6.03/10 after, the QuickDASH score was 56.36/100 before and 53.65/100 after, grip strength was 15.34kg before and 12.8kg after, pinch strength was 3.7kg before and 2.18kg after, Kapandji thumb opposition score was 8.96/10 before and 8.26/10 after. The radiological stage did not change. We noted one case of type 1 complex regional pain syndrome and 12 poor results, 11 of which were reoperated by trapeziectomy. Given our results and the lack of published studies with a high level of evidence, the value of isolated arthroscopy with interposition in the surgical treatment of thumb carpometacarpal osteoarthritis remains to be demonstrated.

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Résumé

Nous avions publié en 2011 de bons résultats sur une série de 25 patients opérés pour rhizarthrose par interposition d’implant d’acide poly-L-lactique sous arthroscopie avec un recul moyen de 14 mois. Le but de ce travail était d’évaluer les résultats avec un recul supérieur. Notre nouvelle série comprenait 26 patients d’âge moyen 60ans, opérés sous arthroscopie par interposition d’implant composé d’acide poly-L-lactique dans 12 cas, et tendineux dans 14 cas. Au recul moyen de 20mois, la douleur évaluée sur une échelle visuelle analogique était en moyenne de 6,61/10 avant intervention et 6,03/10 après intervention, le score QuickDASH passait de 56,36/100 avant à 53,65/100 après, la force de la poigne de 15,34kg avant et 12,8kg après, la pince pollici-digitale termino-latérale de 3,7kg avant et 2,18kg après, le score de Kapandji de 8,96/10 avant et 8,26/10 après. Le stade radiologique ne changeait pas. On notait un syndrome régional complexe de type 1, 12 mauvais résultats repris 11 fois par trapézectomie. D’après nos résultats et l’absence de série publiée avec un niveau de preuve suffisant, l’intérêt de l’arthroscopie simple avec interposition dans le traitement chirurgical de la rhizarthrose reste à démontrer.

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Keywords : Arthroscopy, Thumb carpometacarpal osteoarthritis, Interposition, PLLA, Shrinkage, Shaving

Mots clés : Arthroscopie, Rhizarthrose, Interposition, PLLA, Shrinkage , Shaving




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