Burton and Pellegrini describe LRTI arthroplasty for advanced thumb CMC osteoarthritis. The procedure combines palmar oblique ligament reconstruction using half the FCR tendon with tendon interposition after trapezium excision. This retrospective review of 25 thumbs compares outcomes against a historical silicone implant series.
Simple trapezium excision and silicone implant arthroplasty both leave the thumb metacarpal without ligamentous support, leading to proximal migration, subluxation, and persistent weakness. Silicone implants added their own problems: material wear, cold flow, and foreign-body synovitis.
This paper is the foundation for how we treat advanced thumb CMC arthritis today. When a patient has Eaton stage III or IV basal joint arthritis refractory to conservative management, LRTI is the standard — not simple excision, not silicone implant.
The key technical concept: the FCR slip runs from the radial metacarpal cortex to its intact insertion on the index metacarpal base, recreating the vector of the palmar oblique ligament. This geometry is what prevents both proximal migration and radial subluxation. It is not incidental to the construct.
Counsel patients that maximum recovery takes close to 6 months, and that thenar strengthening must continue for 4 to 6 months after surgery. Early mobility is slower than with silicone, but the long-term stability and strength profile are substantially better.
Burton and Pellegrini describe LRTI arthroplasty for advanced thumb CMC osteoarthritis. The procedure combines palmar oblique ligament reconstruction using half the FCR tendon with tendon interposition after trapezium excision. This retrospective review of 25 thumbs compares outcomes against a historical silicone implant series.
Simple trapezium excision and silicone implant arthroplasty both leave the thumb metacarpal without ligamentous support, leading to proximal migration, subluxation, and persistent weakness. Silicone implants added their own problems: material wear, cold flow, and foreign-body synovitis.
This paper is the foundation for how we treat advanced thumb CMC arthritis today. When a patient has Eaton stage III or IV basal joint arthritis refractory to conservative management, LRTI is the standard — not simple excision, not silicone implant.
The key technical concept: the FCR slip runs from the radial metacarpal cortex to its intact insertion on the index metacarpal base, recreating the vector of the palmar oblique ligament. This geometry is what prevents both proximal migration and radial subluxation. It is not incidental to the construct.
Counsel patients that maximum recovery takes close to 6 months, and that thenar strengthening must continue for 4 to 6 months after surgery. Early mobility is slower than with silicone, but the long-term stability and strength profile are substantially better.