Midterm outcomes following revision of failed trapeziectomy with a costochondral autograft.

Abstract

Painful scaphometacarpal impingement after trapeziectomy with or without tendon interposition and ligament reconstruction can be revised with a costochondral autograft. The aim of this retrospective study was to report the outcomes of this surgical procedure. All patients who were operated between 2014 and 2023 were invited for a final follow-up. Patient-reported outcomes, clinical function, radiologic measurements of thumb length and a questionnaire for thoracic donor site morbidity were evaluated. Out of a total of 43 patients (44 thumbs), 35 patients (36 thumbs) were available for follow-up at a mean follow-up of 71 months (SD 32). The median visual analogue scale score for pain at rest improved from 7 (IQR 5 to 9) preoperatively to 1 (IQR 0 to 5) at follow-up. The score during activities of daily life changed from 9 (IQR 8 to 10) to 5 (1 to 8). The mean brief Michigan Hand Questionnaire score was 53 (SD 24) at the time of follow-up. Twenty-one patients rated their results as good and nine rated them as fair. The median Kapandji index was 9 (IQR 9 to 10) with a median key pinch of 3 kg (IQR 2 to 4). After initial improvement radiological thumb length deteriorated over time to preoperative values. Five out of 35 patients complained about chronic pain at the site of cartilage excision between 1 and 5 on the visual analogue scale. We do not recommend a costochondral autograft as the first choice for revision surgery, but it still could be a solution for recurrent problems. IV.