Trapezium-sparing distraction arthroplasty using the abductor pollicis longus tendon for advanced trapeziometacarpal osteoarthritis: A retrospective case series.

Authors

Cheng-Yeh Lee, Hui-Kuang Huang, Cheng-Yo Yen, Kuei-Yu Liu, Chin-Hsien Wu, Yuan-Kun Tu

Published in

Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association. Nov 10, 2026. Epub Nov 10, 2026.

Abstract

Trapeziectomy is conventionally performed in advanced trapeziometacarpal (TMC) osteoarthritis, often leading to metacarpal subsidence and pinch weakness. Trapezium-preserving techniques offer biomechanical advantages but are typically reserved for early-stage disease. This study evaluated the clinical and radiographic outcomes of trapezium-sparing distraction arthroplasty using the abductor pollicis longus (APL) tendon in advanced TMC osteoarthritis.
We retrospectively reviewed 28 patients who underwent trapezium-sparing distraction arthroplasty with the APL tendon for Eaton-Littler stage III TMC osteoarthritis between 2012 and 2023. The minimum follow-up was 2 years. The outcome measures included the Disabilities of the Arm, Shoulder, and Hand (DASH) score, visual analogue scale (VAS) score, Kapandji opposition score, grip strength, key pinch strength, and radiographic parameters. Preoperative and postoperative values were compared.
The remaining 24 patients (four patients lost follow-up) with a mean age of 55.5 ± 12.3 years and a median follow-up of 91.5 (range, 24.0-151.0) months showed median DASH score decreased from 45.5 to 0, and the median VAS score decreased from 5 to 0. The median grip and key pinch strengths, expressed as percentages of the unaffected hand, increased from 79.0% to 98.7% and from 57.5% to 98.5%, respectively. Twenty-three patients achieved a Kapandji opposition score of 10 (full opposition score). Radiographs showed alignment stabilization and no regrowth of marginal spurs. Four patients (16.7%) demonstrated asymptomatic decreases in the postoperative trapezial space (median, 1.0 mm; range, 0.2-2.3 mm). Residual pain was observed in three patients. No major complications were observed.
Trapezium-sparing distraction arthroplasty using the APL tendon provided significant pain relief, functional improvement, and radiographic stability and may be a reliable alternative to trapeziectomy-based procedures, particularly when preservation of the trapezium is desired.

PMID:
43009348
Bibliographic data and abstract were imported from PubMed on 11 Nov 2026.

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