Modified Eaton-Littler's Reconstruction for Traumatic Thumb Carpometacarpal Joint Instability: Operative Technique and Clinical Outcomes

Abstract

Background Injuries to thumb carpometacarpal joint ligaments lead to instability. Eaton-Littler's ligament reconstruction traditionally uses a strip of flexor carpi radialis to stabilize the CMC joint.

Study Description We have modified this technique to reproduce the direction of active action of the anterior oblique ligament by reconstructing both the volar and dorsoradial ligaments. In this prospective study, we evaluated patients with confirmed traumatic thumb CMC joint instability who underwent modified Eaton-Littler's reconstruction. Strength analysis, Michigan Hand Outcome Questionnaire, QuickDASH, and subjective outcome measures were collected pre- and postoperatively with minimum 3 years of follow-up. Eleven patients were included in the final analysis, with mean age of 29 years (range: 16–52) and average follow-up of 6.2 years (range: 3–11). There was a statistically significant improvement in all outcome measures.

Clinical Relevance Our modified technique helps to simultaneously address both volar and dorsal ligaments and yields satisfactory clinical outcomes at medium term follow-up.

Level of Evidence Level IV, case series.

Keywords

Eaton-Littler's ligament reconstruction - operative technique - prospective study - outcome measures - thumb carpometacarpal joint instability

Note

This study was performed at the Department of Trauma and Orthopaedics at Southport and Ormskirk Hospital NHS Trust, Southport, United Kingdom. The study protocol was approved by the local research and clinical effectiveness departments.

• References

• 1 Edmunds JO. Current concepts of the anatomy of the thumb trapeziometacarpal joint. J Hand Surg Am 2011; 36 (01) 170-182
• 2 Imaeda T, An KN, Cooney III WP, Linscheid R. Anatomy of trapeziometacarpal ligaments. J Hand Surg Am 1993; 18 (02) 226-231
• 3 Haines RW. The mechanism of rotation at the first carpo-metacarpal joint. J Anat 1944; 78 (Pt 1–2): 44-46
• 4 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (08) 1655-1666
• 5 Pellegrini Jr VD, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg Am 1993; 18 (02) 238-244
• 6 Strauch RJ, Behrman MJ, Rosenwasser MP. Acute dislocation of the carpometacarpal joint of the thumb: an anatomic and cadaver study. J Hand Surg Am 1994; 19 (01) 93-98
• 7 Najima H, Oberlin C, Alnot JY, Cadot B. Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis. J Hand Surg Br 1997; 22 (02) 183-188
• 8 Van Brenk B, Richards RR, Mackay MB, Boynton EL. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg Am 1998; 23 (04) 607-611
• 9 Colman M, Mass DP, Draganich LF. Effects of the deep anterior oblique and dorsoradial ligaments on trapeziometacarpal joint stability. J Hand Surg Am 2007; 32 (03) 310-317
• 10 Ladd AL, Lee J, Hagert E. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology. J Bone Joint Surg Am 2012; 94 (16) 1468-1477
• 11 Akmaz I, Kiral A, Pehlivan O, Solakoğlu C. Ligament reconstruction for the chronic instability of the traumatic thumb carpometacarpal joint [Article in Turkish]. Acta Orthop Traumatol Turc 2003; 37 (03) 237-243
• 12 Simonian PT, Trumble TE. Traumatic dislocation of the thumb carpometacarpal joint: early ligamentous reconstruction versus closed reduction and pinning. J Hand Surg Am 1996; 21 (05) 802-806
• 13 Eaton RG, Littler JW. Joint injuries and their sequelae. Clin Plast Surg 1976; 3 (01) 85-98
• 14 Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am 1984; 9 (05) 692-699
• 15 Brunelli G, Monini L, Brunelli F. Stabilisation of the trapezio-metacarpal joint. J Hand Surg Br 1989; 14 (02) 209-212
• 16 Takwale VJ, Stanley JK, Shahane SA. Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament. J Bone Joint Surg Br 2004; 86 (04) 541-545
• 17 Chung KC, Pillsbury MS, Walters MR, Hayward RA. Reliability and validity testing of the Michigan Hand Outcomes Questionnaire. J Hand Surg Am 1998; 23 (04) 575-587
• 18 Beaton DE, Wright JG, Katz JN. ; Upper Extremity Collaborative Group. Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Joint Surg Am 2005; 87 (05) 1038-1046
• 19 Hudak P, Amadio PC, Bombardier C. ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med 1996; 29 (06) 602-608
• 20 Shauver MJ, Chung KC. The Michigan hand outcomes questionnaire after 15 years of field trial. Plast Reconstr Surg 2013; 131 (05) 779e-787e
• 21 Lane LB, Henley DH. Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint. J Hand Surg Am 2001; 26 (04) 686-691
• 22 Van Giffen N, Van Ransbeeck H, De Smet L. Stabilization of the pre-arthritic trapeziometacarpal joint using ligament reconstruction. Chir Main 2002; 21 (05) 277-281
• 23 Nyszkiewicz R, Neumann R. Experiences with Eaton-Littler reconstruction for therapy of ligament instability of the thumb saddle joint [Article in German]. Handchir Mikrochir Plast Chir 2001; 33 (06) 424-430