Clinical Example: Basal Joint Arthroplasty with tendon loop suspension

Basal joint arthroplasty is a common operation and the variations in technical approaches are a common topic of conversation for most hand surgeons. Below is a brief description of a technique for suspension ligament reconstruction. This is one of many possible techniques.
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Summary: after trapeziectomy, a slip of abductor pollicis longus tendon is passed around the base of the index metacarpal and sutured to itself proximal to the metacarpal base.
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In this case, a vena cava ligature passer was modified to create the path around the index metacarpal base.
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This technique allows a strong distal force vector, and care mist be taken to avoid overdistraction.
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Preop basal joint stress views showing subluxation and subsidence:
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8 months postop. The trapeziectomy defect height is still maintained.
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18 months postop, MRI for an unrelated diagnosis demonstrates the tendon loop path in the intermetacarpal space.
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