Thumb basal joint arthritis treatment with biological arthroplasty is a widely used procedure in hand surgery centers. The several described techniques are based on the use of different tendons of the wrist, implying frequently a tenoplasty around flexor carpi radialis or transosseous tunnels to stabilize the articulation. The authors have been using, for many years, the technique conceived by F. Brunelli that relies on the anchorage of the volar band of the abductor pollicis longus tendon to the first intermetacarpal ligament, to obtain a suspension arthroplasty. Technical details are discussed. Sixty-seven patients in Eaton-Littler stage 2 or 3 with >4 years follow-up after surgery were evaluated. Each patient expressed a subjective evaluation relating to pain, functionality, strength, esthetic aspect, and general satisfaction. The following parameters have been considered as objective data: the angle of the first web space, the abduction and opposition of the first digit, the pinch, and the strength. X-rays were also performed to verify the distance between the scaphoid and the first metacarpal. In 84% of cases, a significant improvement was found in the considered parameters. Joint space was maintained in 76% of cases at radiologic follow-up. No patient needed surgical revision. The tenoplasty conceived by F. Brunelli presents several advantages, including the simple and reproducible execution, short surgical time, and comfortable postoperative course for the patient. After mid-term follow-up, authors believe this procedure is particularly respectful of the anatomy and physiology of the first ray and gives optimal results in most of the cases, but, in patients with severe subluxation of the 1st metacarpal (identifiable as Eaton-Littler stage 3), it is less reliable, because of the degeneration of the intermetacarpal ligament.