Preliminary Stage II results

A retrospective assessment evaluated arthro-scopic Stage II patients with adequate follow-up in a selected 3-year period. Forty-three patients (38 female and 5 male) were arthroscopically diagnosed as having Stage II basal joint osteoar-thritis of the thumb between 1998 and 2001. All the procedures were performed by the author, with follow-up data generated by visiting fellows for objectivity. The average patient age was 51 (range: 31-69). The right thumb was involved in 23 patients and the left in 20. There was no improvement after a minimum 6 weeks of conservative treatment under the author's direction. The surgical procedure consisted of arthroscopic synovectomy, debridement, and occasional thermal capsulorraphy, followed by an extension-abduction closing wedge osteotomy in all cases. A 0.045-inch Kirschner wire provided stability to the osteotomy site, and a short arm-thumb spica cast was used for 4 to 6 weeks until pin removal. The average follow-up was 43 months (range: 2464 months).

Consistent arthroscopic findings in the selected group were frank eburnation of the articular cartilage of the ulnar third of the base of the first metacarpal and central third of the distal surface of the trapezium, disruption of the dorsoradial ligament, attenuation of the anterior oblique ligament, and synovial hypertrophy. The osteotomy healed within 4 to 6 weeks in all the cases. Radiographic studies at final follow-up depicted maintenance of centralization of the metacarpal base over the trapezium and no progression of arthritic changes in 42 patients. Average range of thumb MCP joint motion was 5° to 50°, and thumb opposition reached the base of the small finger in all cases. The average pinch strength was 9.5 lbs (73% from nonaffected side). At final follow-up, 37 patients had no pain, 3 had mild pain, 2 had moderate pain, and the only patient who complained of severe pain had undergone arthroscopic-assisted hemitrape-ziectomy because of progressive arthritis. These preliminary results suggest that continued use of this technique is appropriate. A longer follow-up will be later obtained to better assess the long-term utility of this technique and to publish these findings specifically in Stage II patients.

Arthroscopy in patients who had radiographic features of Stage III and IV generally displays widespread full thickness cartilage loss, with or without a peripheral rim on both articular surfaces, severe synovitis; and frayed volar ligaments with laxity (see Figs. 4 and 5). This clearly constitutes arthroscopic Stage III, and the treatment options here are quite varied. The arthroscope can be removed and the most appropriate open procedure performed, or as the author prefers in most cases, an arthroscopic interposition arthroplasty is undertaken.

Based on the above findings and clinical experience, the author proposes the arthroscopic classification and treatment algorithm delineated in Table 1 and Fig. 8.

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