RESUMEN
PURPOSE: This study reviewed the results of the figure-of-eight ligament reconstruction, a technique used in the surgical management of thumb carpometacarpal (CMC) instability. This technique establishes joint stability through forces originating within the CMC joint, providing volar and dorsal support. METHODS: We evaluated the outcomes of 15 patients with nontraumatic, nonarthritic thumb CMC instability treated with the figure-of-eight ligament reconstruction technique. This technique involves routing a graft of the palmaris longus tendon through the base of the first metacarpal and trapezium bone in a figure-of-eight fashion. Preoperative visual analog scale (0-100) for pain and Michigan Hand Outcomes Questionnaire total scores were compared with 3- and 12-month postoperative scores. Secondary outcomes included strength, range of motion, patient satisfaction, return to work, and complications. RESULTS: A significant improvement between intake and 12 months after surgery was observed for both Michigan Hand Outcomes Questionnaire total scores (53, SD 3 vs 70, SD 4) and visual analog scale pain scores (63, SD 4 vs 36, SD 7). Additionally, after surgery, restored thumb CMC joint stability was reported for all patients. Strength and range of motion improved between intake and 12 months after surgery. The median return to work was 6 weeks. Nine (60%) patients rated their satisfaction as "excellent" or "good," and 11 (73%) patients said that they would undergo the surgery again. CONCLUSIONS: The figure-of-eight ligament reconstruction significantly improves pain and function in patients with thumb CMC instability while restoring joint stability and preserving range of motion, making it a suitable technique. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
RESUMEN
BACKGROUND: Surgical management of midcarpal instability (MCI), also referred to as carpal instability nondissociative, remains controversial due to limited evidence on different techniques. This study aimed to assess and compare differences in patient-reported pain, hand and wrist function, patient satisfaction, range of motion, and return to work in patients with non-traumatic MCI who underwent surgical treatment either through dorsal wrist capsulodesis or three-ligament tenodesis (3LT). METHODS: Patients with MCI and persisting complaints after conservative therapy treated with 3LT or dorsal capsulodesis were included. Patients with posttraumatic instability were excluded. Primary endpoints included the Patient Rated Wrist Evaluation (PRWE) and Satisfaction with Treatment Result Questionnaire at 12 months postoperative. All data were retrospectively analyzed. RESULTS: A total of 91 patients treated with dorsal capsulodesis and 21 treated with 3LT between December 2011 and December 2019 were included. At twelve months postoperative, both treatment groups reported significant improvements in pain and function scores. However, at three months postoperative, the dorsal capsulodesis group exhibited significantly better outcomes, followed by a greater return to work (72%) compared to the 3LT group (50%). However, the capsulodesis group demonstrated a decreased range of motion at three months which was restored at 12 months postoperative. No significant difference in satisfaction with treatment was observed. CONCLUSIONS: Both 3LT and dorsal capsulodesis demonstrate promising results for addressing non-traumatic MCI. However, considering the quicker recovery and faster return to work associated with dorsal capsulodesis, we recommend favoring capsulodesis over 3LT when both surgical options are deemed suitable for the patient. LEVEL OF EVIDENCE: III.
