Non-fixed pyrocarbon interposition carpometacarpal arthroplasty

Purpose. – In carpometacarpal (CMC) arthritis of the thumb, the use of interposition techniques (polylactic acid, pyrocarbon, dacron) has been increasing recently. These techniques are most often combined with open or arthroscopic complete or partial trapeziectomy. This article reports the
results at one year of the arthroscopic interposition of an absorbable implant performed without trapeziectomy.
Methods. – Our series included 25 patients aged 60.5 years on average, presenting with osteoarthritis of the trapeziometacarpal joint that had been medically treated for 18.5 months on average. All patients were operated using 1-ulnar (U) and 1-radial (R) portals. After joint debridement, a polylactic acid implant was inserted under arthroscopic control. Outcome evaluation consisted of the assessment of pain intensity, grip strength, pinch strength, opposition, thumb abduction and Dell radiological staging.
Results. – The average follow-up was 14 months. Postoperative radiological data showed significant differences from baseline clinical data regarding all evaluated variables: 0.68 vs. 3.5 for pain, 24.76 Kg vs. 16.64 Kg for grip strength, 6.44 Kg vs. 3.64 Kg for pinch strength, 8.6 vs. 7.28 for opposition, 81.28 vs. 69.68 for thumb abduction, and 1.08 vs. 2.88 on the Dell stage. Eleven complications occurred, including a type 1 complex regional pain syndrome, one sepsis, and nine inflammatory reactions that resolved after an average of 3 weeks.
Conclusions. – Our technique is simple, rapid, cost-effective, and does not necessitate trapeziectomy, even partial. It has the same indications as other non-radical interventions. The follow-up duration of our study was too short for long-term evaluation but short-term outcome appeared superior to that in other published series. The regional inflammatory reactions that occurred in our series were transient and probably related to implant resorption. Our promising results suggest extending the indication of arthroscopic interposition to more advanced stages of proximal joint osteoarthritis.

In this key lecture, Dr. Michel Levadoux gives us an overview of arthroscopic interposition of palmaris lungus (PL) or ½ flexor carpi radialis (FCR) in case of scapholunate advanced collapse (SLAC) wrist stage II.

In this key lecture, Dr. Caloia outlines the principles of repair of acute triangular fibrocartilage complex (TFCC) tears.

The author is presenting anatomical structures visible topographically on the surface of the volar and dorsal part of the wrist in relation to the wrist's inner anatomy. The author gives an X-ray picture, outside and inside topography of the wrist, and describes structures visible by the arthroscope in comparison to an anatomical dissection of radiocarpal and midcarpal joint. The author shows all details necessary for a good wrist access using the arthroscope and gives an overall picture of normal arthroscopic finding.

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In this presentation, we report a convenient and simple technique to arthroscopically repair the distal component of the TFCC.

In this key lecture, Dr. Andrea Atzei focuses on Triangular FibroCartilage Complex (TFCC) tears and arthroscopic TFCC reconstruction.

In this key lecture, Dr. Andrea Atzei presents the new classification of Triangular FibroCartilage Complex (TFCC) tears.

In this key lecture, Dr. Zemirline covers wrist arthroscopy anatomy.

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In this lecture, the principles of Triangular FibroCartilage Complex (TFCC) repair are covered.