Nieuwdorp Niek J, Jongen Isabel C, Hundepool Caroline A, van der Oest Mark J W, Moojen Thybout M, Selles Ruud W, Zuidam J Michiel
From the Departments of Plastic, Reconstructive, and Hand Surgery.
Hand and Wrist Center, Xpert Clinics.
Plast Reconstr Surg. 2025 Mar 1;155(3):533e-542e. doi: 10.1097/PRS.0000000000011709. Epub 2024 Sep 4.
The Eaton-Littler ligament reconstruction is widely used for thumb carpometacarpal instability, yet the existing literature lacks a thorough analysis of the outcomes for nontraumatic instability. This study aimed to assess the outcomes of the Eaton-Littler ligament reconstruction and to identify prognostic factors associated with postoperative pain.
Patients with nontraumatic carpometacarpal joint instability, unresponsive to conservative treatment, were included in this prospective study. The visual analog scale (range 0 to 100) for pain and the Michigan Hand Outcome Questionnaire (MHQ; range 0 to 100) total score were measured at intake and 3 and 12 months postoperatively. Multivariable linear regression was used to analyze the association between preoperative variables and the 12-month MHQ pain score.
Seventy-four patients undergoing Eaton-Littler ligament reconstruction were included. The median visual analog scale pain score improved significantly ( P < 0.001) from intake (70 [interquartile range, 63 to 78]) to 12 months postoperatively (27 [interquartile range, 7 to 56]). The mean MHQ total score also improved significantly ( P < 0.001) from intake (52; SD, 13) to 12 months (74; SD, 17). All thumbs were stable at follow-up with preserved range of motion. Grip and pinch strength also improved significantly after surgery. Undergoing a concurrent surgery during ligament reconstruction and a better MHQ pain score at intake were found to be predictors of a favorable postoperative MHQ pain score.
Patient- and clinician-reported outcomes improved significantly at 3 and 12 months after Eaton-Littler ligament reconstruction. The authors advise concurrent hand pathologies resulting from instability (eg, tendinitis, synovitis) to be treated simultaneously during ligament reconstruction.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
伊顿-利特勒韧带重建术广泛应用于拇指腕掌关节不稳，但现有文献缺乏对非创伤性不稳治疗结果的深入分析。本研究旨在评估伊顿-利特勒韧带重建术的治疗结果，并确定与术后疼痛相关的预后因素。
本前瞻性研究纳入了非创伤性腕掌关节不稳且保守治疗无效的患者。在入院时、术后3个月和12个月测量疼痛的视觉模拟量表（范围0至100）和密歇根手功能结果问卷（MHQ；范围0至100）总分。采用多变量线性回归分析术前变量与术后12个月MHQ疼痛评分之间的关联。
纳入74例行伊顿-利特勒韧带重建术的患者。视觉模拟量表疼痛评分中位数从入院时（70[四分位间距，63至78]）显著改善（P<0.001）至术后12个月（27[四分位间距，7至56]）。MHQ总分均值也从入院时（52；标准差，13）显著改善（P<0.001）至12个月时（74；标准差，17）。所有拇指在随访时均稳定，活动范围保留。术后握力和捏力也显著改善。韧带重建期间同时进行其他手术以及入院时更好的MHQ疼痛评分被发现是术后MHQ疼痛评分良好的预测因素。
伊顿-利特勒韧带重建术后3个月和12个月，患者和临床医生报告的结果均显著改善。作者建议在韧带重建期间同时治疗因不稳导致的并发手部病变（如腱鞘炎、滑膜炎）。
临床问题/证据级别：治疗性，III级。
