Eur J Plast Surg (2004) 27:195 DOI 10.1007/s00238-004-0646-6 AU TH OR’S REPLY L. R. Scheker Commentary on “Dynamic suspension-sling arthroplasty with intermetacarpal ligament reconstruction for the treatment of trapeziometacarpal osteoarthritis” by Scheker LR, Boland MR Published online: 8 July 2004 Springer-Verlag 2004 I thank Mr. David Evans for his thorough review of my article, Davies et al. reported that in their patients who article on dynamic suspension-sling arthroplasty with in- underwent trapeziectomy, most did not progress on to a termetacarpal ligament reconstruction for the treatment of scapho-metacarpal impingement, which clearly implies trapeziometacarpal osteoarthritis. I am also grateful to that some did. I would at this stage like to draw attention him for his kind and well-meaning comments on my to a recent publication which has specifically addressed surgical skills as well as his remarks about the procedure this issue. Kriegs-Au et al.  have prospectively fol- being a considerable sophistication of the original concept lowed patients who underwent ligament reconstruction of “ligament reconstruction-tendon interposition” (LRTI) with or without tendon interposition for a period of 4 described by Burton and Pellegrini . years. They indicate that though there was some evidence Mr. Evans in his commentary has described the pro- of proximal migration of the metacarpal, none of their cedure as being technically difficult which I feel is not patients developed an impingement of the metacarpal the case. I presume he makes these comments based on base with the scaphoid. It is my belief that ligament re- the “apparent complexity” of the manoeuvres involving construction is of vital importance in preventing scapho- stainless steel wire loops. These manoeuvres are in fact metacarpal as well as inter-metacarpal impingement and quite simple and take on a more complex appearance that the technique described in my article provides an when translated into a text form. I have included detailed effective method for achieving that goal. step-by-step diagrams in the article with the express in- I once again thank Mr. Evans for his excellent com- tention of clarifying this point. I do however tend to agree mentary on my technique which I hope will help solve with Mr. Evans that observing the procedure being per- some of the issues confronting the patient suffering from formed is helpful as is indeed the case with any surgery. I an arthritic trapeziometacarpal joint. am reasonably confident that doing so will allay any fears in the minds of hand surgeons regarding the technical aspects of this procedure. It is also my intention to make a References demonstration movie of the procedure available to inter- 1. Burton RI, Pellegrini VD (1986) Surgical management of basal ested surgeons who can contact me at the e-mail address joint arthritis of the thumb. Part II. Ligament reconstruction provided above. with tendon interposition arthroplasty. J Hand Surg [Am] Mr. Evans further raises the issue that certain authors 11:324–332 have questioned the need for preventing proximal mi- 2. Davis TRC, Brady O, Barton NJ et al. (1997) Trapeziectomy alone, with tendon interposition or with ligament reconstruc- gration of the metacarpal. He also indicates that there may tion? A randomized prospective study. J Hand Surg [Br] be grounds to speculate on the ability of a ligament 22:689–694 reconstruction, however strong to start with, to prevent 3. Kreigs-Au G, Petje G, Fojtl E, Ganger R, Zachs I (2004) gradual migration over the long term. He answers these Ligament reconstruction with or without tendon interposi- questions himself when he rightly points out that the study tion to treat primary thumb carpometacarpal osteoarthritis. A prospective randomized study. J Bone Joint Surg Am 86- by Davies et al.  is a short term study where patients A:209–218 were evaluated at 3 months and 1 year only. In their L. R. Scheker ( ) Christine M. Kleinert Institute for Hand and Microsurgery, 225 Abraham Flexner Way Suite 850, Louisville, KY 40202, USA e-mail: email@example.com Tel.: +1-502-5620307, Fax: +1-502-5614288
European Journal of Plastic Surgery – Springer Journals
Published: Aug 1, 2004
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