A Prospective, Randomized Trial of Mobilization Protocols Following Ligament Reconstruction and Tendon Interposition

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Abstract

Background:

The purpose of this study was to evaluate the hypothesis that an increased duration of immobilization following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) leads to improved patient-reported outcomes compared with an early mobilization protocol.

Methods:

At 2 institutions, we prospectively randomized 223 patients (238 thumbs) undergoing LRTI to receive 1 of 2 postoperative rehabilitation protocols. The immobilization protocol consisted of use of a postoperative forearm-based thumb-spica splint for 7 days followed by a forearm-based thumb-spica cast for 5 weeks and then by a custom forearm-based thermoplastic thumb-spica splint for an additional 6 weeks. An active range of motion (ROM) was started 6 weeks postoperatively. The early mobilization protocol consisted of the same postoperative splint for 7 days followed by use of a forearm-based thermoplastic thumb-spica splint for 3 weeks and then by a hand-based thumb-spica splint for 4 weeks. An active ROM was started 4 weeks postoperatively. The outcome measures included the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; pinch and grip strength; 9-hole peg test (NHP); visual analog scale (VAS) for pain; VAS for patient satisfaction; and wrist and thumb ROM. These were measured preoperatively and at 6, 12, 26, 52, and 104 weeks postoperatively. Differences in continuous and categorical variables were assessed with use of Tukey multiple comparisons following 1-way analysis of variance and Fisher exact tests, respectively.

Results:

A minimum follow-up of 1 year (mean, 1.7 years) was achieved for 71% (169) of the 238 randomized thumbs (157 of the 223 patients): 74 patients (80 thumbs) treated with the immobilization protocol and 83 patients (89 thumbs) treated with the early mobilization protocol. DASH scores, VAS pain scores, VAS patient satisfaction scores, and strength all improved similarly with no significant differences between groups at any time point. Wrist and thumb ROM and NHP outcomes were significantly worse for the immobilization group at 6 weeks postoperatively, with no differences observed between groups at 12 weeks and beyond.

Conclusions:

A conservative immobilization protocol does not improve functional outcomes, satisfaction, strength, or ROM following LRTI compared with an early mobilization protocol.

Level of Evidence:

Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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