Ostoearthritis of the trapeziometacarpal (TMC) joint, the key joint in thumb opposition, is one of the most common diseases involving the hand, especially among middle-aged and elderly women, and can seriously impair overall hand function. Previous studies have indicated that joint instability from ligament insufficiency is the pathological mechanism underlying the disease. Therefore, various ligament reconstruction techniques have been developed to improve both the stability and kinematics of the joint. However, none of them involve anatomical ligament reconstruction and are almost always used in combination with trapeziectomy. In order to restore joint stability as well as to save the trapezium, we developed a new technique for reconstructing the anterior oblique ligament of the TMC joint anatomically using the distal part of the transverse carpal ligament. In this article, we describe the technique in detail and report the clinical outcome of 9 patients. 6 of whom were treated by ligament reconstruction alone while the other 3 underwnet ligament reconstruction combined with surface joint replacement. All 9 patients maintained good stability and ROM of the joint at their final follow-up (3 years or longer). Although that follow-up period is admittedly short, we think anatomical ligament reconstruction with or without surface joint replacement is a rational alternative to ligament reconstruction tendon interposition (LITI) prodecures.