Eaton and Littler reported a new ligament reconstruction for the painful, unstable thumb carpometacarpal joint and related its results to the preoperative stage of articular degeneration.
Series of 18 patients treated at Roosevelt Hospital, New York, after splinting and anti‑inflammatory care had failed. Follow‑up was 12 to 60 months.
Methods
Design
Case series of a new ligament reconstruction
Results graded excellent, good or fair
Patients
18 patients with painful, unstable thumb basal joints
Mostly idiopathic or post‑traumatic
Splinting and anti‑inflammatory treatment had failed
Follow‑up 12 to 60 months
Basis
Subluxation, fragment size and joint‑space changes on radiographs (Stages I to IV)
Key Findings
Every patient gained at least partial relief of pain and weakness: 11 of 18 results were excellent, 5 good and 2 fair, so the authors counted no failures.
Outcome tracked the extent of joint degeneration, and strength, motion and pain relief were better when the operation preceded significant radiographic damage.
Grades assigned at 12 months did not change over later follow‑up, and the excellent results lasted through the longest observation (mean follow‑up 30.9 months).
Post‑traumatic joints had 5 excellent and 2 good results, vs 6 excellent, 2 good and 2 fair among idiopathic joints.
Looking back, the authors judged that prosthetic arthroplasty or arthrodesis might have been the better choice for one of the two fair results.
Board pearl
Eaton and Littler saw progressive capsular laxity and hypermobility as the common pathological process behind basal thumb arthrosis, which is the reason they reconstructed the ligament.
Eaton‑Littler stages of basal joint degenerationEaton, J Bone Joint Surg Am 1973
Stage I
Normal articular contours, joint space widened by effusion, less than one‑third subluxation
3 patients, all excellent results
Stage II
Capsular laxity, at least one‑third subluxation, fragments under 2 mm
2 patients, both excellent results
Stage III
More than one‑third subluxation, fragments over 2 mm, slight joint‑space narrowing
8 patients: 5 excellent, 3 good
Stage IV
Major subluxation, very narrow joint space, cystic and sclerotic subchondral changes, trapezial osteophytes
5 patients: 1 excellent, 2 good, 2 fair
Authors' conclusion
Restoration of strength, mobility, and freedom from pain were better if surgery was performed before significant articular damage was noted on roentgenograms.
Eaton and Littler reported a new ligament reconstruction for the painful, unstable thumb carpometacarpal joint and related its results to the preoperative stage of articular degeneration.
Series of 18 patients treated at Roosevelt Hospital, New York, after splinting and anti‑inflammatory care had failed. Follow‑up was 12 to 60 months.
Methods
Design
Case series of a new ligament reconstruction
Results graded excellent, good or fair
Patients
18 patients with painful, unstable thumb basal joints
Mostly idiopathic or post‑traumatic
Splinting and anti‑inflammatory treatment had failed
Follow‑up 12 to 60 months
Basis
Subluxation, fragment size and joint‑space changes on radiographs (Stages I to IV)
Key Findings
Every patient gained at least partial relief of pain and weakness: 11 of 18 results were excellent, 5 good and 2 fair, so the authors counted no failures.
Outcome tracked the extent of joint degeneration, and strength, motion and pain relief were better when the operation preceded significant radiographic damage.
Grades assigned at 12 months did not change over later follow‑up, and the excellent results lasted through the longest observation (mean follow‑up 30.9 months).
Post‑traumatic joints had 5 excellent and 2 good results, vs 6 excellent, 2 good and 2 fair among idiopathic joints.
Looking back, the authors judged that prosthetic arthroplasty or arthrodesis might have been the better choice for one of the two fair results.
Board pearl
Eaton and Littler saw progressive capsular laxity and hypermobility as the common pathological process behind basal thumb arthrosis, which is the reason they reconstructed the ligament.
Eaton‑Littler stages of basal joint degenerationEaton, J Bone Joint Surg Am 1973
Stage I
Normal articular contours, joint space widened by effusion, less than one‑third subluxation
3 patients, all excellent results
Stage II
Capsular laxity, at least one‑third subluxation, fragments under 2 mm
2 patients, both excellent results
Stage III
More than one‑third subluxation, fragments over 2 mm, slight joint‑space narrowing
8 patients: 5 excellent, 3 good
Stage IV
Major subluxation, very narrow joint space, cystic and sclerotic subchondral changes, trapezial osteophytes
5 patients: 1 excellent, 2 good, 2 fair
Authors' conclusion
Restoration of strength, mobility, and freedom from pain were better if surgery was performed before significant articular damage was noted on roentgenograms.