Sage Journals: Discover world-class research

Abstract

Introduction:

Painful scaphometacarpal impingement after trapeziectomy with or without tendon interposition and ligament reconstruction can be revised with a costochondral autograft. The aim of this retrospective study was to report the outcomes of this surgical procedure.

Methods:

All patients who were operated between 2014 and 2023 were invited for a final follow-up. Patient-reported outcomes, clinical function, radiologic measurements of thumb length and a questionnaire for thoracic donor site morbidity were evaluated.

Results:

Out of a total of 43 patients (44 thumbs), 35 patients (36 thumbs) were available for follow-up at a mean follow-up of 71 months (SD 32). The median visual analogue scale score for pain at rest improved from 7 (IQR 5 to 9) preoperatively to 1 (IQR 0 to 5) at follow-up. The score during activities of daily life changed from 9 (IQR 8 to 10) to 5 (1 to 8). The mean brief Michigan Hand Questionnaire score was 53 (SD 24) at the time of follow-up. Twenty-one patients rated their results as good and nine rated them as fair. The median Kapandji index was 9 (IQR 9 to 10) with a median key pinch of 3 kg (IQR 2 to 4). After initial improvement radiological thumb length deteriorated over time to preoperative values. Five out of 35 patients complained about chronic pain at the site of cartilage excision between 1 and 5 on the visual analogue scale.

Conclusion:

We do not recommend a costochondral autograft as the first choice for revision surgery, but it still could be a solution for recurrent problems.

Level of evidence:

Keywords

Costochondral autograft CMC-1-osteoarthritis metacarpal subsidence resection arthroplasty scapohometacarpal impingement

Get full access to this article

View all access options for this article.

References

Chiche

Lamarre

Barbary

Teissier

Scaphometacarpal arthroplasty: a report of ten cases of trapeziometacarpal prosthesis and trapeziectomy revision. J Hand Surg Eur. 2020, 45: 483–7.

Conolly

Rath

Revision procedures for complications of surgery for osteoarthritis of the carpometacarpal joint of the thumb. J Hand Surg Eur. 1993, 18: 533–9.

Davis

TRC

Brady

Dias

. Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition. J Hand Surg Am. 2004, 29: 1069–77.

Dréant

. Mini TightRope^® suture button indications for thumb basal joint arthritis. Hand Surg Rehabil. 2021, 40S: S77–82.

Duché

Trabelsi

The concept of first metacarpal M1-M2 arch. New interest in trapeziometacarpal prostheses. Hand Surg Rehabil. 2022, 41: 163–70.

Gervis

WH.

Osteo-arthritis of the trapezio-metacarpal joint treated by excision of the trapezium. Proc R Soc Med. 1947, 40: 492.

Glard

Gay

Valenti

Berwald

Guinard

Legré

Costochondral autograft as a salvage procedure after failed trapeziectomy in trapeziometacarpal osteoarthritis. J Hand Surg Am. 2006, 31: 1461–7.

Guerrero

Ferlauto

Grier

Wahl

Richard

Ruch

DS.

Suspensionplasty for revision thumb carpometacarpal osteoarthritis surgery: comparing suture button suspensionplasty to ligament reconstruction and tendon interposition. Plast Reconstr Surg. 2022, 150: 601–5.

Herren

DB.

Basal thumb arthritis surgery: complications and its management. J Hand Surg Eur. 2024, 49: 188–200.

10.

Herren

Fuchs

Schindele

Marks

Outcomes and recommendations for revision of thumb carpometacarpal resection arthroplasty. J Hand Surg Eur. 2021, 46: 1101–7.

11.

Herren

Boeckstyns

Chung

, et al. Diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy: a Delphi study. J Hand Surg Eur. 2024, 49: 1235–42.

12.

Hizal

Buyuklu

Ozer

Cakmak

Effects of different levels of crushing on the viability of rabbit costal and nasal septal cartilages. Plast Reconstr Surg. 2011, 128: 1045–51.

13.

T-VT

Sykes

Kriet

Humphrey

. Cartilage graft donor site morbidity following rhinoplasty and nasal reconstruction. Craniomaxillofacial Trauma Reconstr. 2018, 11: 278–84.

14.

Johnson

Chung

KC.

Revision thumb carpometacarpal arthroplasty. Hand Clin. 2022, 38: 249–59.

15.

Kapandji

[Clinical test of apposition and counter-apposition of the thumb]. Ann Chir Main. 1986, 5: 67–73.

16.

Knobloch

Kraemer

Papst

Sorg

Vogt

PM.

German version of the brief Michigan Hand Outcomes Questionnaire: implications for early quality of life following collagenase injection in Dupuytren contracture. Plast Reconstr Surg. 2012, 129: 886e–7e.

17.

Koo

MY.

A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med. 2016, 15: 155–63.

18.

Mattila

Waris

. Revision of trapeziometacarpal arthroplasty: risk factors, procedures and outcomes. Acta Orthop. 2019, 90: 389–393.

19.

Mattila

Haapamäki

Waris

Interposition of free vascularized fascia into the trapezial resection cavity for the surgical treatment of trapeziometacarpal osteoarthritis. Microsurgery. 2024, 44: e31221.

20.

Megerle

Grouls

Germann

Kloeters

Hellmich

Revision surgery after trapeziometacarpal arthroplasty. Arch Orthop Trauma Surg. 2011, 131: 205–10.

21.

Pouedras

Chaves

Gaisne

Ardouin

Bellemère

Pyrocardan^® implant after failed trapeziectomy. Hand Surg Rehabil. 2021, 40: 51–6.

22.

Richards

Trickett

RW.

A systematic review of management options for symptomatic scaphometacarpal impingement after trapeziectomy. J Hand Surg Eur. 2024, 49: 1340–9.

23.

Shelat

Eileen

John

Teo

Vijayan

Chiu

MT.

Chronic pain and its impact on quality of life following a traumatic rib fracture. Eur J Trauma Emerg Surg. 2012, 38: 451–5.

24.

Streiner

. Starting at the beginning: an introduction to coefficient alpha and internal consistency. J Pers Assess. 2003, 80: 99–103.

25.

Szalay

Scheufens

Alt

Thormann

Heiss

Erfahrungen mit dem Mini TightRope bei schmerzhafter Proximalisierung des 1. Mittelhandstrahls nach Trapezektomie bei Rhizarthrose [Primary results using the mini TightRope for revision surgery for painful proximalisation of the first metacarpal after trapezectomy for CMC-1-osteoarthritis]. Handchir Mikrochir Plast Chir. 2015, 47: 17–23.

26.

Tang

Giddins

Why and how to report surgeons’ levels of expertise. J Hand Surg Eur. 2016, 41: 365–6.

27.

Umarji

Arnander

Evans

DM.

The use of Swanson silastic interposition arthroplasty in revision thumb-base surgery for failed trapeziectomy; a case series of 10 patients. J Hand Surg Eur. 2012, 37: 632–6.

28.

Yin

Gilula

. Imaging of the symptomatic wrist. In: Watson

Weinzweig

(Eds.) The Wrist. Philadelphia, Lippincott-Raven, 2001: 61–82.

Midterm outcomes following revision of failed trapeziectomy with a costochondral autograft

Abstract

Introduction:

Methods:

Results:

Conclusion:

Level of evidence:

Keywords

Get full access to this article

References