Procedure 61 Trapeziometacarpal Ligament Reconstruction
See Video 45: Thumb CMC Joint Beak Ligament Reconstruction Using the FCR Tendon
Examination/Imaging
Clinical Examination
The clinician should stress the trapeziometacarpal (TMC) joint and note any instability and laxity. The extent of ligament rupture (partial versus complete) allows varying degrees of hypermobility. Although hypermobility may be present bilaterally, greater excursion and symptomatic hypermobility should be evident on the affected side.
Imaging
A lateral and pronated anteroposterior radiograph should be obtained to evaluate any existing joint disease and to identify the more commonly seen Bennett fracture-dislocation.
A stressed anteroposterior radiograph of the bilateral thumbs with radial margins pressed together can help elucidate the degree of capsule laxity and presents both thumb joints for comparison (Fig. 61-1).
Surgical Anatomy
The TMC joint is a biconcave saddle-shaped joint that provides motion in several planes to allow thumb flexion, extension, abduction, adduction, and opposition.
The volar oblique (beak) ligament inserts volarly onto the trapezium from its confluence with articular cartilage on the beak of the thumb metacarpal and is considered the primary stabilizer of the TMC joint. It serves as the main restraint against dorsal translation of the metacarpal on the trapezium (Fig. 61-2).
The palmar cutaneous branch of the median nerve is located 1 mm ulnar to the FCR tendon.
