DOI: https://doi.org/10.36347/sasjs.2026.v12i07.009

Pages: 627-630

Background: Trapeziometacarpal (TMC) osteoarthritis often inflicts profound pain and functional limitations on patients [1]. Simple trapeziectomy provides robust pain relief but frequently causes proximal migration (subsidence) of the first metacarpal, compromising thumb stability [2]. This case report outlines a soft-tissue-only suspensionplasty that bypasses bone tunnel creation by transposing an Abductor Pollicis Longus (APL) tendon slip directly onto the distal insertion of the Flexor Carpi Radialis (FCR) [3]. Case Description: A 72-year-old, left-hand-dominant female presented with a 3-year history of worsening left thumb base pain from Eaton-Littler Stage III TMC osteoarthritis [4]. Following a complete excision of the trapezium, stabilization was achieved without osseous drilling. An APL tendon slip was isolated, keeping its distal attachment, and woven securely under tension to the sturdy distal insertion of the FCR tendon at the base of the second metacarpal [3]. This construct acted as a functional dynamic sling. Discussion: Standard ligament reconstruction often relies on drilling bone tunnels, a step that adds technical complexity and poses a distinct risk of metacarpal fracture [5]. In contrast, anchoring the APL directly to the FCR distal insertion exploits native anatomical support, avoiding hardware or bone trauma while effectively combating vertical subsidence [3,6]. Conclusion: At the 2-month follow-up mark, the patient enjoyed complete resolution of pain, near-perfect opposition (Kapandji score of 9/10), and clear functional recovery [7]. Post-operative imaging verified a well-preserved trapezial space. This tunnel-free approach offers a reliable, low-morbidity option for treating severe thumb basal joint arthritis [3].