Jeffrey Alan Marchessault, Benjamin Roy Smith, Alexandra Jordan Johnson, William David Currie
{"title":"在基底关节炎的情况下，比较拇指掌指关节固定术和外侧骨板囊锁术治疗掌指关节过伸--一项病例对照研究。","authors":"Jeffrey Alan Marchessault, Benjamin Roy Smith, Alexandra Jordan Johnson, William David Currie","doi":"10.5435/JAAOSGlobal-D-25-00032","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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°.</p><p><strong>Discussion and conclusion: </strong>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.</p>","PeriodicalId":45062,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","volume":"9 4","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939946/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparison of Thumb Metacarpophalangeal Arthrodesis to Volar Plate Capsulodesis for Metacarpophalangeal Hyperextension in the Setting of Basal Joint Arthritis-A Case-Control Study.\",\"authors\":\"Jeffrey Alan Marchessault, Benjamin Roy Smith, Alexandra Jordan Johnson, William David Currie\",\"doi\":\"10.5435/JAAOSGlobal-D-25-00032\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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°.</p><p><strong>Discussion and conclusion: </strong>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.</p>\",\"PeriodicalId\":45062,\"journal\":{\"name\":\"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews\",\"volume\":\"9 4\",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-03-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11939946/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5435/JAAOSGlobal-D-25-00032\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Academy of Orthopaedic Surgeons Global Research and Reviews","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5435/JAAOSGlobal-D-25-00032","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}
Comparison of Thumb Metacarpophalangeal Arthrodesis to Volar Plate Capsulodesis for Metacarpophalangeal Hyperextension in the Setting of Basal Joint Arthritis-A Case-Control Study.
Introduction: 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.
Methods: 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.
Results: 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°.
Discussion and conclusion: 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.
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