The Eaton-Littler Ligament Reconstruction in Thumb Carpometacarpal Joint Instability: Outcomes and Prognostic Factors in 74 Patients.

Background: The Eaton-Littler ligament reconstruction is widely used for thumb carpometacarpal (CMC) instability, yet the existing literature lacks a thorough analysis of the outcomes for nontraumatic instability. This study aimed to assess the outcomes of the Eaton-Littler ligament reconstruction and to identify prognostic factors associated with postoperative pain.

Methods: Patients with nontraumatic CMC joint instability, unresponsive to conservative treatment, were included in this prospective study. The Visual Analogue Scale (VAS, range 0-100) for pain and the Michigan Hand Outcome Questionnaire (MHQ, range 0-100) total score were measured at intake and three and 12-months postoperative. Multivariable linear regression was used to analyze the association between preoperative variables and the 12-month MHQ pain score.

Results: Seventy-four patients undergoing Eaton-Littler ligament reconstruction were included. The median VAS pain score improved significantly (P<0.001) from intake (70 [interquartile range (IQR) 63-78]) to 12 months postoperatively (27 [IQR 7-56]). The mean MHQ total score also improved significantly (P<0.001) from intake (52, standard deviation (SD) 13) to 12 months (74, SD 17). All thumbs were stable at follow-up whilst preserving the range of motion. Grip and pinch strength also improved significantly following surgery. Undergoing a concurrent surgery during ligament reconstruction and a better MHQ pain score at intake were found to be predictors of a favorable postoperative MHQ pain score.

Conclusions: Patient- and clinician-reported outcomes improved significantly at three and 12 months after Eaton-Littler ligament reconstruction. We advise concurrent hand pathologies resulting from instability (e.g., tendinitis, synovitis) to be treated simultaneously during ligament reconstruction.

Level Of Evidence: Therapeutic, II.