Multicenter RCT of 183 thumbs randomized to simple trapeziectomy, trapeziectomy with palmaris longus interposition, or trapeziectomy with FCR ligament reconstruction and tendon interposition (Burton-Pellegrini). All patients received K-wire fixation for 4 weeks and splinting for 6 weeks. The study asks whether adding soft tissue reconstruction to trapezium excision improves outcomes at 1 year.
For decades, concern about thumb shortening and pseudarthrosis instability after simple trapeziectomy drove adoption of increasingly complex reconstructions — culminating in the Burton-Pellegrini LRTI as the dominant procedure. This Level I RCT directly challenges that paradigm.
When planning surgery for CMC OA, this paper supports trapezium excision as the essential therapeutic step. Neither palmaris longus interposition nor the Burton-Pellegrini FCR LRTI added measurable benefit in pain, strength, or function at 1 year. Across 183 thumbs.
When counseling patients preoperatively, set the expectation that strength will not be back to baseline at 3 months. Significant pinch strength gains take until 12 months. Patients who worry about weakness at their 3-month visit are on a normal trajectory.
One important caveat: all three groups in this study received K-wire fixation and 6-week immobilization. The simple trapeziectomy arm here resembles "hematoma and distraction arthroplasty" more than standard trapeziectomy. Do not assume results transfer directly to trapeziectomy performed without these adjuncts.
Multicenter RCT of 183 thumbs randomized to simple trapeziectomy, trapeziectomy with palmaris longus interposition, or trapeziectomy with FCR ligament reconstruction and tendon interposition (Burton-Pellegrini). All patients received K-wire fixation for 4 weeks and splinting for 6 weeks. The study asks whether adding soft tissue reconstruction to trapezium excision improves outcomes at 1 year.
For decades, concern about thumb shortening and pseudarthrosis instability after simple trapeziectomy drove adoption of increasingly complex reconstructions — culminating in the Burton-Pellegrini LRTI as the dominant procedure. This Level I RCT directly challenges that paradigm.
When planning surgery for CMC OA, this paper supports trapezium excision as the essential therapeutic step. Neither palmaris longus interposition nor the Burton-Pellegrini FCR LRTI added measurable benefit in pain, strength, or function at 1 year. Across 183 thumbs.
When counseling patients preoperatively, set the expectation that strength will not be back to baseline at 3 months. Significant pinch strength gains take until 12 months. Patients who worry about weakness at their 3-month visit are on a normal trajectory.
One important caveat: all three groups in this study received K-wire fixation and 6-week immobilization. The simple trapeziectomy arm here resembles "hematoma and distraction arthroplasty" more than standard trapeziectomy. Do not assume results transfer directly to trapeziectomy performed without these adjuncts.