Excision of the Flexor Carpi Radialis Tendon Following Ligament Reconstruction Tendon Interposition for Thumb Carpometacarpal Arthroplasty: A Review of Cases and of the Literature

Thumb carpometacarpal (CMC) arthroplasty predictably improves pain and function in patients with thumb CMC osteoarthritis. One variation of this technique involves using a split half flexor carpi radialis (FCR) tendon for ligament reconstruction tendon interposition. Postoperative pain in the wrist and distal forearm overlying the remaining FCR tendon is a potential complication that may necessitate follow-up FCR tenotomy. Being aware of this potential complication and modifying surgical technique if a poor quality tendon is discovered at the time of the initial surgery may decrease the incidence of postoperative FCR pain and the need for reoperation. We retrospectively reviewed a consecutive series of 200 thumb CMC arthroplasties involving ligament reconstruction tendon interposition using split half FCR tendon grafts. Of these, we present 4 patients of 200 (2%) who developed FCR area pain in the wrist and distal forearm after undergoing thumb CMC arthroplasty who eventually required FCR tenotomy at a mean of 5 months. In this paper, we provide recommendations that may reduce the incidence of this under-discussed complication for surgeons utilizing split half FCR tendon grafts: (1) when harvesting the graft, split the tendon exactly down the middle while also attempting to preserve the tendon sheath, and (2) opt to harvest the entire tendon if it appears thin or otherwise diseased intraoperatively.