Background: Many surgical procedures for the treatment of trapeziometacarpal arthritis have been described. Most procedures consist of an open procedure that involves bone resection, ligament reconstruction, and an interpositional arthroplasty. An innovative technique of arthroscopic trapeziometacarpal joint debridement with substance interposition was developed by Dr. Jay Menon in the early 1990’s for patients in the early stages of the disease. In 1996, he reported good short term results over an average of 3 years. As interest in minimally invasive surgery has increased, so has interest in this technique. No long-term follow up of this procedure has been assessed or reported, in large part due to the untimely death of Dr. Menon. The purpose of our study was to determine the long-term outcomes of this arthroscopic procedure and factors affecting outcome.

Methods: A retrospective study was performed with patients identified by reviewing surgical logs from 1990 to 1998. Patients not having undergone revision were contacted and completed a pain questionnaire and the DASH (Disabilities of Arm, Shoulder, Hand) questionnaire. Clinical and radiographic assessment was then performed.

Results: Arthroscopic operations were performed on 41 thumbs from 1990 to 1998. Material for interpositional arthroplasties was either cadaveric fascia lata, Goretex tape, or autogenous tendon (palmaris longus or flexor carpi radialis). Outcomes of 18 of the operations were unknown because patients died or were lost to follow-up. Of the remaining 23 operations, 34% (8 operations) were considered failures and required salvage procedures for recurrent symptoms. The remaining 66% were considered successes and were still doing well with an average postoperative follow-up time of 9.3 years. These patients had an average pain score of 1.3 (scale 1-5, 5 the worst), and a high satisfaction rate (93% were very happy with the results). They also had a high functional level based on answers from the DASH questionnaire. Most of the successful operations had autogenous tendon interpositions (60%), whereas most of the failures had cadaveric fascia lata or Goretex interpositions.

Conclusions: The long-term outcome of arthroscopic trapeziometacarpal arthroplasty is favorable and affords good pain relief and patient satisfaction. The interpositional material has a strong affect on the success of this procedure. This operation may be a viable surgical alternative in patients with early trapeziometacarpal arthritis. It may be also particularly useful in the younger patient population either preventing or delaying the need for trapeziectomy, ligament reconstruction and tendon interposition.