Marchessault Jeffrey Alan, Smith Benjamin Roy, Johnson Alexandra Jordan, Currie William David
From the Division of Orthopaedic Surgery, Department of Surgery, East Tennessee State University (Dr. Marchessault, Dr. Smith, and Dr. Johnson); and the Department of Statistics, East Tennessee State University, Johnson City, TN (Dr. Currie).
J Am Acad Orthop Surg Glob Res Rev. 2025 Mar 25;9(4). doi: 10.5435/JAAOSGlobal-D-25-00032. eCollection 2025 Apr 1.
Surgical treatment of metacarpophalangeal (MCP) joint hyperextension in the treatment of thumb basal joint arthritis can be categorized as motion preserving and arthrodesis. We compared minimum 2-year results between nonsurgical thumbs and thumbs undergoing ligament reconstruction with tendon interposition (LRTI) alone, thumb MCP arthrodesis, and volar plate capsulodesis as adjunct procedures to LRTI.
Single surgeon patients with thumb MCP hyperextension >30° underwent arthrodesis or volar plate capsulodesis with LRTI. Thirty-one LRTI thumbs were compared with 22 LRTI with arthrodesis (LRTI + A), 21 LRTI with MCP capsulodesis (LRTI + C), and 65 nonsurgical controls. Patient-reported outcome measures were recorded with grip strength, tip pinch, lateral pinch, opposition, and pre-/postoperative hyperextension measured by one of the authors.
No difference was found in Michigan Hand Questionnaire scores (P = 0.13), QuickDASH values (P = 0.38), or visual analog scale results (P = 0.86). No difference was observed in grip strength (P = 0.97) or tip pinch (P = 0.66). Lateral pinch was decreased between LRTI and nonsurgical thumbs but not when compared with groups with adjunct MCP procedures (P = 0.0064). LRTI + A had the least opposition (P < 0.001). In the LRTI + C group, MCP hyperextension worsened in two patients (9%) and 14 of 22 (63%) had postoperative values equal or greater than 30°.
Our LRTI + C cohort experienced persistent MCP hyperextension, with mean postoperative hyperextension of >30°. Despite the literature suggesting that this portends inferior outcomes, our LRTI + C cohort demonstrated near-equal outcomes when compared with the LRTI, LRTI + A, and control groups. We no longer perform capsulodesis for MCP hyperextension and offer arthrodesis for MCP arthrosis or hyperextension not actively correctable by the patient.
在拇指掌指关节关节炎的治疗中，掌指关节（MCP）过伸的手术治疗可分为保留运动功能的手术和关节融合术。我们比较了非手术治疗的拇指与仅接受肌腱间置韧带重建术（LRTI）、拇指MCP关节融合术以及作为LRTI辅助手术的掌侧板关节囊固定术的拇指至少2年的治疗结果。
拇指MCP过伸大于30°的单术者患者接受了LRTI联合关节融合术或掌侧板关节囊固定术。将31例接受LRTI的拇指与22例接受LRTI联合关节融合术（LRTI + A）、21例接受LRTI联合MCP关节囊固定术（LRTI + C）的拇指以及65例非手术对照进行比较。由作者之一记录患者报告的结局指标，包括握力、指尖捏力、侧捏力、对掌力以及术前/术后过伸情况。
密歇根手功能问卷评分（P = 0.13）、QuickDASH值（P = 0.38）或视觉模拟量表结果（P = 0.86）均未发现差异。握力（P = 0.97）或指尖捏力（P = 0.66）也未观察到差异。LRTI组与非手术治疗的拇指相比，侧捏力有所下降，但与接受MCP辅助手术的组相比则无差异（P = 0.0064）。LRTI + A组的对掌力最小（P < 0.001）。在LRTI + C组中，2例患者（9%）的MCP过伸情况恶化，22例中有14例（63%）术后过伸值等于或大于30°。
我们的LRTI + C队列出现了持续的MCP过伸，术后平均过伸大于30°。尽管文献表明这预示着较差的结局，但与LRTI组、LRTI + A组和对照组相比，我们的LRTI + C队列显示出近乎相等的结局。我们不再对MCP过伸进行关节囊固定术，而是对MCP关节病或患者无法主动纠正的过伸情况采用关节融合术。
