Ligament reconstruction and tendon interposition (LRTI)

This chapter details the steps in performing a ligament reconstruction and tendon interposition. A subperiosteal longitudinal capsulotomy between the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons is made over the carpometarcarpal and scaphotrapezial joint. The trapezium is dissected and osteophytic bone between base of thumb and index metacarpal is removed. A bone tunnel is created through the first metacarpal. The ulnar half of the flexor carpi radialis (FCR) tendon is transected at the musculotendinous junction and is then passed through the bone tunnel. The tendon is tied and sutured onto itself using Krackow style technique. Remaining tendon is rolled and secured into the arthroplasty space. Indications, essential steps, postoperative care, and sample operative dictation are included.