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Ligament Reconstruction With Tendon Interposition Using an Acellular Dermal Allograft for Thumb Carpometacarpal Arthritis

Kokkalis, Zinon T. MD; Zanaros, George MD; Sotereanos, Dean G. MD

Techniques in Hand & Upper Extremity Surgery: March 2009 - Volume 13 - Issue 1 - p 41-46
doi: 10.1097/BTH.0b013e31818be857
Technique

Ligament reconstruction tendon interposition arthroplasty is currently the preferred technique for carpometacarpal joint arthritis of the thumb by most surgeons. Despite its efficacy, morbidity has been associated with the harvest of the flexor carpi radialis tendon. Using an allograft as material for arthroplasty, donor site morbidity is avoided. In this report, we present our surgical technique to perform ligament reconstruction tendon interposition arthroplasty using an acellular dermal matrix allograft (GraftJacket) in patients with Eaton stages II, III, and IV symptomatic first carpometacarpal arthritis.

One hundred thumbs with trapeziometacarpal osteoarthritis underwent surgical treatment using GraftJacket allograft instead of the flexor carpi radialis tendon autograft. Each patient was followed for a minimum of 12 months. The surgical procedure included trapezial excision and identification of the flexor carpi radialis. The allograft was cut to create a 15-cm strip. The ligament reconstruction was performed by passing the strip around the flexor carpi radialis tendon and suturing it to the base of the thumb metacarpal base through an intramedullary drill hole. The remaining portion of the allograft was fashioned as an interposition mass (anchovy) and interposed between the scaphoid and the base of the first metacarpal.

All but 1 patient experienced significant improvement in his or her pain scale rating and grip and pinch strengths. Outcomes from this study compare very favorably with those of other series. No patients experienced a foreign body reaction or infection in this series. We believe that the use of an acellular dermal allograft for both ligament reconstruction and tendon interposition provides a safe and an effective alternative technique for the treatment of advanced first carpometacarpal arthritis.

From the Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Allegheny General Hospital, Pittsburgh, PA.

In support of their research for or preparation of this manuscript, one of the authors (D.G.S.) received grants or outside funding from Wright Medical Technology, Inc, Arlington, Tenn. Also, a commercial entity (Wright Medical Technology) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other nonprofit organization with which the authors are affiliated or associated.

Address correspondence and reprint requests to Dean G. Sotereanos, MD, Department of Orthopaedic Surgery, Hand & Upper Extremity Surgery, Drexel University, School of Medicine, Allegheny General Hospital, 1307 Federal St, 2nd Floor, Pittsburgh, PA 15212. E-mail: dsoterea@hotmail.com.

© 2009 Lippincott Williams & Wilkins, Inc.