Volar Plate Advancement and Abductor Pollicis Brevis Tenodesis for Thumb Metacarpophalangeal Joint Hyperextension Correction

Document Type : TECHNICAL NOTE


1 University Pittsburgh Medical Center, Pittsburgh, PA, USA

2 Perimeter Orthopaedics, Atlanta, GA, USA

3 Wexford Hand and Shoulder Center, Wexford, PA, USA


First carpometacarpal (CMC1) osteoarthritis can be accompanied by the collapse of the first ray, with hyperextension of 
the first metacarpophalangeal (MCP1) joint. It is suggested that failure to address substantial MCP1 hyperextension 
during CMC1 arthroplasty may diminish post-operative capability and increase collapse reoccurrence. An 
arthrodesis is recommended in case of severe MCP1 joint hyperextension (>400
). We describe a novel combination 
of a volar plate advancement and abductor pollicis brevis tenodesis to address MCP1 hyperextension at the time 
of CMC1 arthroplasty as an alternative to joint fusion. In 6 women, mean MCP1 hyperextension with pinch before 
surgery was 450
 (range 300
) and improved to 210
 (range 150
) of flexion with pinch six months after surgery. 
No revision surgery has been necessary to date, and there were no adverse events. Long-term outcome data is 
needed to establish the longevity of this procedure as an alternative to joint fusion, but early results are promising. 
Level of evidence: IV


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