Thumb arthroplasty using the abductor pollicis longus (APL) tendon. A, One leash of APL tendon is harvested. Second incision is made over tendon at distal third of forearm; one leash of tendon is divided at muscle junction and passed beneath fascia distally into incision. B, A 3.5-mm hole is drilled at base of the thumb metacarpal from point 1 cm distal to base, through bone in dorsal-to-volar fashion. A second 3.5-mm hole is drilled at base of index metacarpal, 1 cm distal to its base in radiovolar-to-ulnodorsal fashion. C, APL tendon is passed through holes in index and thumb metacarpals and then pulled snugly outside wrist to remove slack in tendon. D, APL graft is passed back inside wrist above extensor carpi radialis longus (ECRL) and volar to dorsal radial artery (radial a), flexor carpi radialis (FCR), extensor pollicis longus (EPL), and extensor pollicis brevis (EPB) tendons. Numbers indicate sequence of construction. E, Thumb metacarpal is distracted to maintain carpometacarpal joint space while 1.6-mm (0.062 inch) Kirschner wire is inserted percutaneously 1 cm distal to thumb metacarpal and advanced through the index metacarpal. APL, abductor pollicis longus; ECRL, extensor carpi radialis longus; EPB, extensor pollicis brevis; EPL, extensor pollicis longus; FCR, flexor carpi radialis.