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Ligament Reconstruction and Tendon Interposition (LRTI)

Ligament reconstruction and tendon interposition (LRTI) is an effective surgical procedure performed on patients suffering from the effects of basilar joint arthritis, or arthritis of the thumb that is non responsive to conservative treatment.  It is also used to treat some carpal metacarpal (CMC) instability cases.

The LRTI procedure uses the body’s own tissue to address the instability and reduction in grip strength that basilar joint arthritis patients may experience.

During the procedure either a partial or complete resection of the trapezium, one of the eight carpal bones, is performed. The palmar oblique ligament is then recreated using the distally based radial half of the flexor carpus radialis (FCR) tendon, in order to reconstruct ligamentous support for the metacarpal.  This will prevent radial subluxation. The remaining tendon is arranged in the opened area from which the trapezium was removed - stabilizing and strengthening the joint.

LRTI provides patients with long-term improvement in both grip and pinch strength. The use of a patients own tissue has also resulted in a lower complication rate.

Often, carpal tunnel syndrome accompanies basilar joint arthritis.  In this case, an endoscopic carpal tunnel release may be performed at the same time.

A splint is worn for approximately one week following the LRTI procedure. A cast is then worn for approximately three to four weeks.

Hand therapy may be indicated to regain thumb strength and range of motion, but generally just a few sessions. Once the cast is removed a removable splint is worn full-time for two weeks, except when bathing, and then only as needed.

Patients are advised to avoid rigorous activity such as forceful gripping and heavy lifting for three to four months following LRTI surgery. Computer use and other light daily tasks may be performed as soon as the day following surgery.