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Yamaura K, Inui A, Mifune Y, Mukohara S, Furukawa T, Kuroda R. Efficacy of Abductor Pollicis Longus Suspension Arthroplasty Combined With Mini TightRope for Osteoarthritis of Thumb Carpometacarpal Joint. Hand (N Y) 2024; 19:419-425. [PMID: 36113054 PMCID: PMC11067831 DOI: 10.1177/15589447221120849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND We aimed to evaluate the efficacy of abductor pollicis longus (APL) suspension arthroplasty with trapeziectomy combined with first and second metacarpal fixation using suture button device. METHODS Thirteen patients (14 thumbs) who underwent APL suspension arthroplasty combined with suture button device for osteoarthritis of the carpometacarpal joint of the thumb (Eaton grade III: 6 and IV: 8 thumbs) at our institution between 2015 and 2019 and were followed up for more than 24 months were included in the study. Preoperative and postoperative range of motion (ROM) of radial and palmar abduction, grip and key pinch strength, visual analog scale (VAS) scores for pain, and the trapezial space ratio (TSR) on radiographic images before and after surgery were statistically examined. RESULTS The mean age of the patients was 59.6 ± 8.1 years, and the mean follow-up period was 45.4 ± 12.2 months. While grip and pinch strength did not significantly change between preoperative and final follow-up measurements, the ROM of radial and palmar abduction and the VAS score at the latest follow-up were significantly better than the preoperative values (P < .05). The mean TSR immediately after surgery and at the latest follow-up was 0.28 ± 0.089 and 0.22 ± 0.084, respectively, indicating a mean reduction rate of 23.3 ± 15.2%. CONCLUSIONS This surgical technique showed significant improvement in the ROM of radial and palmar abduction and the VAS score for pain, and the combined fixation of the first and second metacarpals with suture button device suppressed the subsidence of the first metacarpal.
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Cohen-Shohet R, Morgan A. Surgical Treatment of Advanced Carpometacarpal Joint Arthritis: Trapeziectomy with Hematoma Arthroplasty. Hand Clin 2022; 38:199-205. [PMID: 35465937 DOI: 10.1016/j.hcl.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Osteoarthritis of the first carpometacarpal joint is common. When nonoperative measures fail, surgery may provide long-term pain relief. There are many surgical options in the management of carpometacarpal joint arthritis. Trapeziectomy with hematoma arthroplasty is technically simple, inexpensive, and has withstood the test of time. It is an excellent option for advanced carpometacarpal joint arthritis with multiple high-quality studies showing equivalent outcomes between this technique and ligament reconstruction tendon interposition techniques. This article reviews trapeziectomy with hematoma arthroplasty for treatment of carpometacarpal joint arthritis, including the indications for the procedure, the authors' preferred technique, and the current literature.
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Affiliation(s)
- Rachel Cohen-Shohet
- University of Florida Plastic and Reconstructive Surgery, Halifax Health, 311 North Clyde Morris Boulevard, Suite 500, Daytona Beach, FL 32114, USA.
| | - Aaron Morgan
- Medical College of Wisconsin, 1155 North Mayfair Road, Wauwatosa, WI 53226, USA
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Mirza A, Mirza JB, Klingbeil L, Pavlik JF, Muratori J, Thomas T. A Modified Suture Suspension Arthroplasty Technique for the Treatment of Basal Joint Arthritis: Short- to Intermediate-Term Outcomes. Hand (N Y) 2021; 16:797-803. [PMID: 31916458 PMCID: PMC8647329 DOI: 10.1177/1558944719886669] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Background: To present a retrospective study on the outcomes of a modified version of suture suspension arthroplasty with trapeziectomy on patients with thumb basal joint arthritis and to evaluate the relationship between the degree of subsidence and functional outcome. Methods: We performed a chart review on 67 patients (75 thumbs) who were surgically treated for thumb carpometacarpal osteoarthritis with trapeziectomy and suture suspension arthroplasty from May 2010 to May 2016. Outcome measures included Disabilities of the Arm, Shoulder and Hand (DASH), grip strength, lateral/precision pinch strength, range of motion, and return to work/resumption of usual activities. Radiographic images were used to measure first metacarpal subsidence into the trapezial space. Results: Clinical outcomes were satisfactory, showing an initial postoperative DASH score of 45.94, which decreased to 27.93 at 6 months postoperatively and to 19.69 at 1 year postoperatively. Radiographic images revealed a mean first metacarpal subsidence of 39% compared with the preoperative images. Grip and pinch strengths showed steady improvement from initial postoperative to final follow-up visits, resulting in 90% recovery of gross grasp, 77% recovery of lateral pinch, and 79% recovery of precision pinch compared with the contralateral side. Conclusions: Our study has found that suture suspension arthroplasty with trapeziectomy is an effective treatment for thumb basal joint arthritis. Suture suspension arthroplasty allows for short immobilization time, avoids tendon sacrifice, avoids anchor use, and leaves a cosmetically appealing scar. Furthermore, a relationship of any significance between postoperative first metacarpal subsidence and functional outcomes does not appear.
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Affiliation(s)
- Ather Mirza
- North Shore Surgi-Center, Smithtown, NY, USA,Mirza Orthopedics, Smithtown, NY, USA,Ather Mirza, Mirza Orthopedics, 290 East Main Street, Suite 200, Smithtown, NY 11787, USA.
| | - Justin B. Mirza
- North Shore Surgi-Center, Smithtown, NY, USA,Mirza Orthopedics, Smithtown, NY, USA
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Cerny MK, Aitzetmueller MM, Stecher L, Brett EA, Machens HG, Duscher D, Erne H. Geographical differences in carpometacarpal joint osteoarthritis treatment of the thumb: A survey of 1138 hand surgeons from the USA and Europe. J Plast Reconstr Aesthet Surg 2021; 74:1854-1861. [PMID: 33454226 DOI: 10.1016/j.bjps.2020.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/29/2020] [Accepted: 12/17/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Carpometacarpal osteoarthritis of the thumb (CMC OA) is treated with various therapeutic approaches. However, the literature remains inconclusive regarding the ideal procedure for each disease stage. In this study, we assessed the international application of surgical treatment options including CMC I implants and non-surgical treatment options for CMC OA depending on the disease stage, with a strong focus on the detection of geographical disparities. METHODS We conducted a large international online survey with members of hand surgical societies of the International Federation of Societies for Surgery of the Hand (IFSSH). The first part of the survey asked about general therapy options of CMC OA depending on the severity of the disease, whereas the second part specifically dealt with the use of prostheses. RESULTS We could include 10 of 56 IFSSH member societies (6807 surgeons) and received answers from 1138 members (16.7%). Significant differences were detected in an increased use of corticosteroid injections in the USA, and a growing frequency of fat injections in Europe. Regarding use and frequency of the resection arthroplasty, we found similar results in all participating countries. Prosthetic implantation showed a significant difference between the USA and Europe, with far larger numbers stated by European hand surgeons. CONCLUSION CMC OA is treated differently in the participating countries depending on the stage of the disease. We give an insight into geographical differences in treatment paradigms, with corticosteroid injections being more prevalent in the USA, and prosthesis implantation being more frequently chosen in the selected European countries.
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Affiliation(s)
- Michael K Cerny
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Matthias M Aitzetmueller
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Lynne Stecher
- Institute for Medical Informatics, Statistics and Epidemiology, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Elizabeth Anne Brett
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Hans-Günther Machens
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Dominik Duscher
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany.
| | - Holger Erne
- Department for Plastic and Hand Surgery, Technical University Munich, Ismaninger Strasse 22, 81675 Munich, Germany
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F. Brunelli Ligamentoplasty as Treatment in Thumb Basal Joint Arthritis: Up to 9 Years Follow-up. Tech Hand Up Extrem Surg 2020; 25:77-83. [PMID: 32740056 DOI: 10.1097/bth.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Thumb basal joint arthritis treatment with biological arthroplasty is a widely used procedure in hand surgery centers. The several described techniques are based on the use of different tendons of the wrist, implying frequently a tenoplasty around flexor carpi radialis or transosseous tunnels to stabilize the articulation. The authors have been using, for many years, the technique conceived by F. Brunelli that relies on the anchorage of the volar band of the abductor pollicis longus tendon to the first intermetacarpal ligament, to obtain a suspension arthroplasty. Technical details are discussed. Sixty-seven patients in Eaton-Littler stage 2 or 3 with >4 years follow-up after surgery were evaluated. Each patient expressed a subjective evaluation relating to pain, functionality, strength, esthetic aspect, and general satisfaction. The following parameters have been considered as objective data: the angle of the first web space, the abduction and opposition of the first digit, the pinch, and the strength. X-rays were also performed to verify the distance between the scaphoid and the first metacarpal. In 84% of cases, a significant improvement was found in the considered parameters. Joint space was maintained in 76% of cases at radiologic follow-up. No patient needed surgical revision. The tenoplasty conceived by F. Brunelli presents several advantages, including the simple and reproducible execution, short surgical time, and comfortable postoperative course for the patient. After mid-term follow-up, authors believe this procedure is particularly respectful of the anatomy and physiology of the first ray and gives optimal results in most of the cases, but, in patients with severe subluxation of the 1st metacarpal (identifiable as Eaton-Littler stage 3), it is less reliable, because of the degeneration of the intermetacarpal ligament.
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One-Year Outcomes of Intraarticular Fat Transplantation for Thumb Carpometacarpal Joint Osteoarthritis: Case Review of 99 Joints. Plast Reconstr Surg 2020; 145:151-159. [PMID: 31592943 DOI: 10.1097/prs.0000000000006378] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study aims to present a new therapeutic option for the treatment of thumb carpometacarpal joint osteoarthritis. Knowing that autologous fat may be beneficial for osteoarthritis through antiinflammatory and chondroprotective effects, the authors transplanted autologous adipose fat into the thumb carpometacarpal joint with the objective of postponing definite resection arthroplasty surgery. METHODS In this pilot study, the authors performed surgery on 99 joints. The study population consisted of patients with symptomatic and radiologically confirmed osteoarthritis of the thumb carpometacarpal joint. After harvesting abdominal adipose tissue, 1 to 2 ml of fat without physical or enzymatic manipulation were transplanted into the thumb carpometacarpal joint. Surgical outcome was quantified by use of the Michigan Hand Outcomes Questionnaire in addition to strength and pain measurements during a 12-month follow-up consultation. We conducted Friedman's analysis of variance to gauge the differences over time regarding Michigan Hand Outcomes Questionnaire and pain under stress. RESULTS From 2 weeks on, there was pain relief, both under stress and at rest. Friedman's analysis of variance revealed a significant change in pain under stress [chi-square (5) = 68.52; p < 0.001]. Postoperative Michigan Hand Outcomes Questionnaire Scores improved significantly over 12 months [chi-square (5) = 90.56; p < 0.001]. CONCLUSION The authors' preliminary findings suggest that intraarticular autologous fat transplantation is a promising alternative treatment of carpometacarpal joint osteoarthritis of the thumb. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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DeGeorge BR, Chawla SS, Elhassan BT, Kakar S. Basilar Thumb Arthritis: The Utility of Suture-Button Suspensionplasty. Hand (N Y) 2019; 14:66-72. [PMID: 30188195 PMCID: PMC6346358 DOI: 10.1177/1558944718798850] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We sought to compare the functional outcomes, radiographic outcomes, and complications of trapeziectomy and flexor carpi radialis (FCR) to abductor pollicis longus (APL) side-to-side tendon transfer with or without suture-button suspensionplasty for thumb basilar joint arthritis. METHODS Patients treated with and without suture-button suspensionplasty were compared over a 6-year period. Data were reviewed for complications and functional outcomes, including grip and pinch strength, range of motion, and visual analog scale (VAS) pain scores. Plain radiographs were independently reviewed at initial presentation and at final follow-up, including proximal phalanx length, trapezial space height, and trapezial height ratio. RESULTS Seventy thumb arthroplasties were performed in 70 patients. Trapeziectomy with FCR-APL side-to-side tendon transfer was performed in 39 patients, and trapeziectomy with FCR-APL side-to-side tendon transfer with suture-button suspensionplasty was performed in 31 patients. Mean length of follow-up was 28.4 ± 3.9 and 23.8 ± 2.6 months, respectively. Postoperative grip, oppositional and appositional pinch strength, and VAS pain scores improved compared with preoperative values, but were not significantly different based on suture-button suspensionplasty. Percentage decline in trapezial space ratio was significantly different between groups at 36.7% and 20.4% for procedures with and without suture-button suspensionplasty, respectively indicating that the trapezial space was better maintained within the suture suspension cohort. The incidence of postoperative complications, including surgical site infection, paresthesias, reoperation, complex regional pain syndrome, and symptomatic subsidence, was not significantly different between groups. CONCLUSIONS Trapeziectomy with FCR to APL side-to-side tendon transfer with and without suture-button suspensionplasty results in comparable improvement in pain, grip strength, and functional parameters. Suture-button suspensionplasty results in significantly greater preservation of trapezial space.
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Affiliation(s)
| | | | | | - Sanjeev Kakar
- Mayo Clinic, Rochester, MN, USA,Sanjeev Kakar, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Wang T, Zhao G, Rui YJ, Mi JY. Outcomes of modified trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: Two-year follow-up. Medicine (Baltimore) 2018; 97:e0235. [PMID: 29595674 PMCID: PMC5895363 DOI: 10.1097/md.0000000000010235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Numerous arthroplasty techniques had been reported for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis. The purpose of our study is to evaluate long-term clinical and radiographic outcomes of patients who underwent modified trapeziectomy with ligament reconstruction tendon interposition (LRTI).Our retrospective study included 20 consecutive patients with advanced thumb CMC arthritis receiving modified trapeziectomy with LRTI (20 thumbs). For clinical evaluation, we assessed visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) scores and Kapandji index. Additionally, the grip, pinch power and waist flexion power, radial and volar abduction angle were evaluated, As for radiologic evaluation, we just estimated height of the trapezial space.We took 2-year follow-up. All patients showed decreased VAS from 6.8 preoperatively to 1.4. Mean DASH and Kapandji scores were improved from 52.2 preoperatively to 21.6 and from 6.4 preoperatively to 7.4, respectively. Compared to preoperative range of motion (ROM) for radial abduction and volar abduction, both markedly increased at 2-year follow-up (from 61.2 to 80.1, from 60.6 to 78.3, respectively). Besides, mean power improved from 15.9 preoperatively to 21.7 kg at 2-year follow-up for grip power, from 1.9 preoperatively to 3.5 kg at 2-year follow-up for tip pinch; however, mean waist flexion power showed no significant change from 20.5 preoperatively to 19.7 kg at 2-year follow-up. Notably, there was no significant sinking in height of the trapezial space from 10.0 preoperatively to 9.6 mm at 2-year follow-up. NO case had a complication at final follow-up.Modified trapeziectomy with LRTI treating thumb CMC arthritis in Eaton stage III-IV had a satisfactory efficacy. This new procedure is able to provides enough support for thumb to prevents thumb sinking.
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You JP, Lu L, Li CJ, Ren B, Wang T. Modified trapeziectomy with ligament reconstruction tendon interposition for the treatment of advanced thumb carpometacarpal arthritis: A case report. Medicine (Baltimore) 2018; 97:e9665. [PMID: 29384844 PMCID: PMC5805416 DOI: 10.1097/md.0000000000009665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Thumb carpometacarpal (CMC) arthritis is a common disease. Various procedures have been described for the treatment of advanced thumb CMC arthritis. This essay shows a CMC arthritis case treated by modified trapeziectomy with ligament reconstruction tendon interposition (LRTI). PATIENT CONCERNS A 53-year-old Chinese female complained of pain and swelling at the base of the left thumb for 10 years. Visual analog scale (VAS) for thumb was 7 points, Disabilities of Arm, Shoulder and Hand (DASH) score was 51 points, and Kapandji score was 6 points before surgery. Preoperative range of motion (ROM) for radial abduction and volar abduction were 63°and 62°, respectively. Grip power was 15.3 kg and key-pinch power was 1.8 kg before operation. Preoperative waist flexion power was 20.9 kg. Hand x-ray showed left thumb CMC arthritis in Eaton stage III and the height of the trapezial space was 10 mm. DIAGNOSES She was diagnosed with left thumb CMC arthritis (Eaton III stage). INTERVENTIONS The patient underwent modified trapeziectomy with LRTI. After exposing and removing trapezium, and a hole from the dorsal base to the center of the articular surface was drilled. Then we cut the whole flexor carpi radialis and divided it into 2 halves. Afterward, we passed one-half through the hole and tied it to the other part and sutured them. The rest tendon was then tied continuously and sutured. Then we rolled it up into the space where previous trapezium was located. OUTCOMES Two years after operation, pain and swelling relieved and no recurrence of the clinical symptoms occurred. VAS, DASH, and Kapandji score were 2, 22, 7 points, respectively. ROM for radial abduction and volar abduction were 79° and 78°, respectively. Furthermore, grip power was 22.7 kg and key-pinch power was 3.8 kg. Waist flexion power was 20.0 kg. Hand x-ray showed that the height of the trapezial space was 9.8 mm. LESSONS Modified trapeziectomy with LRTI in treatment of advanced thumb CMC arthritis had a satisfactory efficacy. This new procedure not only prevents thumb sinking, but also provides enough support for thumb.
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Affiliation(s)
| | - Lu Lu
- Department of Anesthesiology
| | | | | | - Tao Wang
- Department integrated Chinese and Western medicines. Affiliated Hospital of Hebei University, Baoding, China
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Desai MJ, Brogan DM, Richard MJ, Mithani SK, Leversedge FJ, Ruch DS. Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis. Hand (N Y) 2016; 11:438-443. [PMID: 28149211 PMCID: PMC5256658 DOI: 10.1177/1558944716643119] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The purpose of this study was to compare the initial biomechanical strength of trapeziectomy and suture-button suspensionplasty (SBS) with ligament reconstruction and tendon interposition (LRTI) for thumb carpometacarpal (CMC) arthritis in a cadaveric model. Methods: Eight matched pairs of below-elbow cadaveric arms were used for this study. Each specimen was randomly assigned to either receive a trapeziectomy and LRTI (LRTI group) or trapeziectomy and SBS (SBS group). Using previously described and validated testing protocols, physiological key pinch was simulated. The thumb metacarpal was then incrementally loaded from 5 to 20 lbs, using 5-lb increments. Metacarpal subsidence during physiological key pinch and incremental loading was determined using radiographic measurements of trapezial space height. Results: The average pretesting trapezial space height did not differ significantly between the LRTI (11.9 mm) and SBS (13.7 mm) groups. After simulated physiological key pinch, the SBS group had significantly greater average trapezial space height compared with the LRTI group (8.0 mm vs 5.5 mm). For each incremental metacarpal load from 5 to 20 lbs, the SBS group had significantly greater average trapezial space height than the LRTI group. Conclusions: In a cadaveric model, SBS demonstrates greater resistance to metacarpal subsidence with immediate loading compared with LRTI.
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Affiliation(s)
- Mihir J. Desai
- Vanderbilt University, Nashville, TN, USA,Mihir J. Desai, Department of Orthopaedics, Vanderbilt University, 1215 21st Ave S., MCE S. Tower Suite 3200, Nashville, TN 37232-8828, USA.
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Rubino M, Cavagnaro L, Sansone V. A new surgical technique for the treatment of scaphotrapezial arthritis associated with trapeziometacarpal arthritis: the narrow pseudoarthrosis. J Hand Surg Eur Vol 2016; 41:710-8. [PMID: 26453601 DOI: 10.1177/1753193415609656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/24/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED We describe a technique for treating Eaton stage IV osteoarthritis of the first ray, which is a development of our previously published technique for treating trapeziometacarpal arthritis. This simple technique is based on a limited resection arthroplasty of the first trapeziometacarpal and the scaphotrapezial joints, with the aim of inducing the formation of a narrow pseudoarthrosis at both sites. A total of 26 consecutive patients were treated for Eaton stage IV arthritis at a mean follow-up of 4.7 years (range 3.2-6.6). There were statistically significant improvements in all clinical parameters: mean appositional and oppositional pinch strength, mean DASH score (65 points pre-operatively to 8.7 points at final follow-up), and in mean visual analogue scale score (8.6 to 0.2 points). Although a larger cohort and a longer follow-up will be necessary to evaluate this new technique fully, these results encourage us to believe that the limited excision arthroplasty of the trapeziometacarpal and scaphotrapezial joints is a viable alternative to the existing surgical treatments for stage IV thumb arthritis. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M Rubino
- Istituto Ortopedico Galeazzi IRCCS, Milano, Italy
| | - L Cavagnaro
- Clinica Ortopedica dell'Università degli Studi di Genova, Genova, Italy
| | - V Sansone
- Orthopaedic Department of the Università degli Studi di Milano, Istituto Ortopedico Galeazzi IRCCS, Milano, Italy
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Corain M, Zampieri N, Mugnai R, Adani R. Interposition Arthroplasty Versus Hematoma and Distraction for the Treatment of Osteoarthritis of the Trapeziometacarpal Joint. J Hand Surg Asian Pac Vol 2016; 21:85-91. [DOI: 10.1142/s2424835516500132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Various surgical techniques were reported with excellent result for the treatment of trapeziometacarpal joint arthritis. However, the best treatment option was not defined yet. Methods: This randomized prospective study compared the result of two surgical techniques: tendon interposition arthroplasty (64 patients) and K. wire distraction (56 patients) after trapeziectomy for stage 3 or 4 osteoarthritis of the trapeziometacarpal joint. Results: After a mean follow-up period of 6.8 (range, 3-10) years it was possible to observe a higher rate of pain relief following trapeziectomy with K. wire suspension, but no significant differences in strength, range of motion and DASH score between the two groups. On lateral unloaded radiographs the height of the space between the base of the thumb metacarpal and the scaphoid showed a mean value of 6.5 mm for both groups; the average distance between the metacarpal base and the trapezium was not statistically significant in the two groups. Complications were observed only in patients treated with trapeziectomy and interposition arthroplasty and were represented by tendinitis of the FCR in 15% of cases. Conclusions: We demonstrate that the trapezium excision and bone space distraction technique requires a smaller incision, a shorter surgical time, an easier surgical technique, and a less painful recovery, maintaining overlapping levels of functional restore.
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Affiliation(s)
- Massimo Corain
- Department of Hand Surgery, University Hospital of Verona, Verona,Italy
| | - Nicola Zampieri
- Department of Surgical Sciences, University Hospital of Verona, Verona, Italy
| | - Raffaele Mugnai
- Department of Hand Surgery, University Hospital of Verona, Verona,Italy
| | - Roberto Adani
- Department of Hand Surgery, University Hospital of Verona, Verona,Italy
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Arthroscopic partial trapeziectomy and tendon interposition for thumb carpometacarpal arthritis. J Orthop Surg Res 2015; 10:184. [PMID: 26684740 PMCID: PMC4683864 DOI: 10.1186/s13018-015-0329-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 11/30/2015] [Indexed: 11/21/2022] Open
Abstract
Background The purpose of this study was to introduce arthroscopic partial trapeziectomy and tendon interposition for the treatment of symptomatic thumb carpometacarpal arthritis of Eaton stage II or III. Methods From August 2001 to April 2009, 23 patients with thumb carpometacarpal arthritis were treated using this technique. Pain score, range of motion, and pinch strength were clinically evaluated and compared with the preoperative values after a minimum follow-up duration of 24 months. Results Significant reduction in pain score and increases in range of motion and pinch strength were found (all p < 0.001) after a 2-year follow-up. The mean ± SD (median) postoperative pain score was 1.0 ± 0.7 (1.0) at rest and 1.3 ± 0.9 (1.0) during daily activities. The postoperative range of motion was 19.1° ± 4.2° (20°) for extension and 35.7° ± 7.1° (35.0°) for flexion, and the postoperative pinch strength was 86.5 % ± 19.9 % (90.0 %). No complications were observed in our patient series. Conclusions Arthroscopic partial trapeziectomy and soft tissue interposition could be an alternative treatment method for patients with symptomatic thumb carpometacarpal arthritis of Eaton stage II or III.
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Hamann N, Heidemann J, Heinrich K, Wu H, Bleuel J, Gonska C, Brüggemann GP. Stabilization effectiveness and functionality of different thumb orthoses in female patients with first carpometacarpal joint osteoarthritis. Clin Biomech (Bristol, Avon) 2014; 29:1170-6. [PMID: 25266241 DOI: 10.1016/j.clinbiomech.2014.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thumb orthoses have to reconcile and satisfy competing goals: stability and mobility. The purpose of the study was to characterize the stabilization effectiveness and functionality of different thumb carpometacarpal osteoarthritis orthoses. METHODS Eighteen female carpometacarpal osteoarthritis subjects were included. Four orthoses were compared: BSN medical (BSN); Push braces (PUSH); Sporlastic (SPOR); and medi (MEDI). Three-dimensional thumb kinematics during active opposition-reposition with and without orthosis was quantified. Ranges-of-motion of the carpometacarpal and metacarpophalangeal joint in x- (flexion-extension), y- (adduction-abduction) and z-direction (pronation-supination) were determined. Hand functionality was examined by Sollerman test. FINDINGS All orthoses restricted carpometacarpal range-of-motion in all directions. In x-direction carpometacarpal range-of-motion was smallest with MEDI and BSN, in y-direction largest with PUSH compared to all other orthoses, in z-direction smaller with BSN and MEDI compared to PUSH, but similar to SPOR. All orthoses restricted metacarpophalangeal range-of-motion in x-direction, except PUSH. In x-direction metacarpophalangeal range-of-motion was smallest with MEDI compared to all other orthoses. In y-direction and z-direction only BSN and MEDI restricted metacarpophalangeal range-of-motion. Sollerman score was highest with PUSH, lowest with MEDI and both differed from other orthoses. Values for BSN and SPOR were similar and lay between PUSH and MEDI. INTERPRETATION Stabilization is borne by functionality. The high stabilization effectiveness provided by MEDI resulted in lowest hand functionality. PUSH, which partially stabilized the CMC joint and allowed large motions in the MCP joint, afforded largest hand functionality. Best compromise of stability and functionality could be reached with BSN. Long-term studies are needed to monitor clinical efficacy.
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Affiliation(s)
- Nina Hamann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany.
| | - Jörn Heidemann
- Joint Centre Brühl, Franziskanerhof 3a, 50321 Brühl, Germany
| | - Kai Heinrich
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Han Wu
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Judith Bleuel
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Christiane Gonska
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933 Cologne, Germany
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Hamann N, Heidemann J, Heinrich K, Wu H, Bleuel J, Gonska C, Brüggemann GP. Effect of carpometacarpal joint osteoarthritis, sex, and handedness on thumb in vivo kinematics. J Hand Surg Am 2014; 39:2161-7. [PMID: 25245769 DOI: 10.1016/j.jhsa.2014.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the influence of trapeziometacarpal (TMC) osteoarthritis (OA) on the 3-dimensional motion capability of the TMC and thumb metacarpophalangeal (MCP) joints. In order to examine other factors affecting the thumb's motion kinematics, we further aimed to address the influence of sex and handedness on the motion capability of normal TMC and MCP joints. METHODS We included 18 healthy subjects (9 women, 9 men; 8 dominant hands, 10 nondominant hands) and 18 women with stage II/III TMC OA. A motion analysis system using surface markers was used to quantify the thumb's 3-dimensional opposition-reposition kinematics. The range of motion of the thumb's TMC and MCP joints in flexion-extension, abduction-adduction, and pronation-supination were determined. RESULTS TMC OA led to a loss in abduction-adduction in the TMC joint (38° in controls, 26° in TMC OA subjects), although neither flexion-extension nor pronation-supination were affected. At the MCP joint, the TMC OA subjects showed a 48% reduction in abduction-adduction (32° controls, 16° TMC OA subjects) and 42% reduction in pronation-supination (34° in controls, 20° in TMC OA subjects) than the healthy controls. Ranges of motion of the healthy TMC and MCP joints were similar in dominant and nondominant hands as well as in women and men. DISCUSSION The study demonstrated that stage II/III TMC OA restricts the motion of the TMC joint in abduction-adduction and of the MCP joint in abduction-adduction and pronation-supination. Thumb motion capability was unaffected by sex and handedness. CLINICAL RELEVANCE Osteoarthritis-induced loss of TMC motion did not reflect a generalizable clinical parameter, rather, it seemed to distinctly affect the TMC and the MCP joints and their motion planes and directions. As neither sex nor handedness influenced the motion capabilities of the healthy thumb, kinematic factors contributing to TMC OA may develop at a later age.
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Affiliation(s)
- Nina Hamann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany.
| | - Jörn Heidemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany
| | - Kai Heinrich
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany
| | - Han Wu
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany
| | - Judith Bleuel
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany
| | - Christiane Gonska
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne; Joint Centre Brühl, Brühl, Germany
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van der Veen FJC, White DN, Dapper MML, Griot JPWD, Ritt MPJF. Clinical Evaluation of the Articulinx Intercarpometacarpal Cushion for the First CMC Joint: A Feasibility Study. J Wrist Surg 2013; 2:276-281. [PMID: 24436828 PMCID: PMC3764246 DOI: 10.1055/s-0033-1353243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background The Intercarpometacarpal Cushion (ICMC; Articulinx, Cupertino, CA, USA) is an implantable spacer designed as a less invasive surgical treatment for osteoarthritis (OA) of the first carpometacarpal joint (CMC-1). Description of Technique Following local anesthesia and exposure of the joint capsule the ICMC, attached to a needle and suture tethers, is guided into the joint space under fluoroscopic visualization through a dorsal approach. The needle is pulled through the thenar eminence to the opposite side of the hand and, once proper device placement is confirmed, cut free and the joint capsule closed. Patients and Methods Eight female patients (median age 56 years; range, 42-83) were treated and followed for 6 to 24 months. Safety of the implant procedure was evaluated intraoperatively. Pain, joint function, and strength were evaluated at 6 weeks, 3, 6, 12 and 24 months with a Visual Analog Scale (VAS) for pain, the QuickDASH inventory, Canadian Occupational Performance Measure (COPM), and pinch and grip strength measurements. Results At 2 years (n = 6), mean VAS pain scores decreased from 6.3 (± 1.5) to 2.2 (± 1.1) (p < 0.001), mean QuickDASH scores improved from 47 (± 15) to 31 (± 11) (p < 0.10), mean COPM performance scores improved from 5.0 (± 1.2) to 5.5 ( ± 1.3) (p = NS). Mean pinch and grip strength measurements also improved compared with baseline. No serious adverse events occurred. Two device removals occurred, associated with a traumatic event and Stage IV OA with device displacement, at 6 and 9 months respectively. Conclusion The ICMC can be implanted safely. Effectiveness needs to be confirmed in future studies.
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Affiliation(s)
- Fiente J. C. van der Veen
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - David N. White
- Department of Plastic Surgery, Palo Alto Medical Foundation, Palo Alto, California
| | - Mattie M. L. Dapper
- Department of Occupational Therapy, VU University Medical Center, Amsterdam, The Netherlands
| | - J. Peter W. don Griot
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Marco P. J. F. Ritt
- Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
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Gillis J, Calder K, Williams J. Review of thumb carpometacarpal arthritis classification, treatment and outcomes. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2013. [PMID: 23204884 DOI: 10.1177/229255031101900409] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Thumb carpometacarpal osteoarthritis (CMC OA) is a common disease, affecting up to 11% and 33% of men and women in their 50s and 60s, respectively, which leads to pain, laxity and weakness of the CMC joint. Based on the staging of the CMC OA, different forms of treatment can be used, including both conservative and surgical measures. Surgical options include osteotomy, trapezial excision, ligament reconstruction with or without tendon interposition, and various prosthetic interpositional implants with or without trapezial excision. The present article reviews the staging of CMC OA, the evaluation of hand function using patient-reported questionnaires, and outcomes of both conservative and surgical treatments. The present review also introduces a commercially available interpositional spacer surgical technique for CMC OA and the early evidence that the literature has shown for improving hand function, strength and stability of the thumb CMC joint postoperatively.
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Suture-button suspensionplasty for thumb carpometacarpal arthritis: a minimum 2-year follow-up. J Hand Surg Am 2013; 38:1161-5. [PMID: 23647637 DOI: 10.1016/j.jhsa.2013.02.040] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 02/22/2013] [Accepted: 02/23/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To retrospectively review the results at a minimum of 2 years of suture-button plasty with partial or full trapeziectomy and suture-button suspensionplasty. METHODS We evaluated 21 patients who received suture-button suspensionplasty at least 2 years after surgery. We measured postoperative pinch strength, grip strength, range of motion, and metacarpal height. All patients also completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire. RESULTS At an average follow-up of 2.8 ± 0.7 years, the mean Quick Disabilities of the Arm, Shoulder, and Hand score was 10 ± 9. Pinch and grip strengths were 86% and 89% of the contralateral limb, respectively. Average first trapezial height was 74% of the contralateral trapezial height. There were no major complications. CONCLUSIONS The favorable results of the suture-button suspensionplasty procedure confirm its usefulness in treating thumb carpometacarpal arthritis with minimal risk of complications, ineffective fixation, or loss of function. Subjective and objective outcomes measures are similar to previously described techniques. The benefit of this technique results from the implanted nature of the suspensionplasty elements that require no time to heal, so rehabilitation is begun as early as 10 days postoperatively. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Abstract
BACKGROUND The safety and the effects of different trajectories on thumb motion of suture-button suspensionplasty post-trapeziectomy are not known. METHODS In a cadaveric model, thumb range of motion, trapeziectomy space height, and distance between the device and nerve to the first dorsal interosseous muscle (first DI) were measured for proximal and distal trajectory groups. Proximal trajectory was defined as a suture button angle directed from the thumb metacarpal to the second metacarpal at a trajectory less than 60° from the horizontal; distal trajectory was defined as a suture button angle directed from the thumb metacarpal to the second metacarpal at a trajectory of greater than 60° from the horizontal (Fig. 1). RESULTS There were no significant differences in range of motion and trapeziectomy space height between both groups. The device was significantly further away from the nerve to the first DI in the proximal trajectory group compared to the distal trajectory group, but was still safely away from the nerve in both groups (greater than 1 cm). CONCLUSIONS These results suggest that the device placement in either a proximal or distal location on the second metacarpal will yield similar results regarding safety and thumb range of motion.
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Affiliation(s)
- Yohan Song
- />Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St, Pavilion C, Redwood City, CA 94063 USA
| | - Christopher A. Cox
- />Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St, Pavilion C, Redwood City, CA 94063 USA
| | - Jeffrey Yao
- />Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St, Pavilion C, Redwood City, CA 94063 USA , />450 Broadway Street, MC 6342 Pavilion A, 2nd floor, Department A26, Redwood City, CA 94063 USA
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Ataker Y, Gudemez E, Ece SC, Canbulat N, Gulgonen A. Rehabilitation protocol after suspension arthroplasty of thumb carpometacarpal joint osteoarthritis. J Hand Ther 2013; 25:374-82; quiz 383. [PMID: 22975741 DOI: 10.1016/j.jht.2012.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 05/23/2012] [Accepted: 06/06/2012] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective case series. INTRODUCTION When conservative modalities and therapies fail to control symptoms of thumb carpometacarpal (CMC) joint osteoarthritis, surgery may be indicated. PURPOSE OF THE STUDY To present a rehabilitation protocol used in a series of patient cases after suspension arthroplasty and to evaluate outcomes. METHODS Twenty-seven patients with CMC osteoarthritis were treated by the same arthroplasty technique and the same rehabilitation program. Patients were evaluated before and 12th week after surgery, and at the last follow-up using a visual analog scale; the Disability of the Arm, Shoulder, and Hand questionnaire; strength measurements; range of motion evaluations; and radiographic assessment. RESULTS Average follow-up period was 31.5 months. There was a decreasing trend in both subjective scores during follow-ups (p=0.0001). Thirty-three percent and 30% improvements on radial and palmar abductions, respectively, and 29% improvement on pinch strengths were recorded at the final follow-up. Postoperative grip improvement was not preserved at the last follow-up. CONCLUSIONS The results demonstrate a high degree of patient satisfaction suggesting the efficacy of this surgical technique and postoperative rehabilitation protocol. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Yaprak Ataker
- Department of Physical Medicine and Rehabilitation, Vehbi Koc Foundation, American Hospital, Istanbul, Turkey.
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Abstract
Trapeziectomy has been regaining popularity in treatment of thumb carpometacarpal (CMC). Current approaches to trapeziectomy use Kirschner wire fixation to prevent subsidence of the thumb metacarpal into the newly created trapeziectomy space. This fixation method requires at least 4 weeks of strict immobilization of the thumb. A technique using a suture-button device to suspend the thumb allows for earlier mobilization of the thumb and potentially leads to a faster overall recovery. Preliminary results are promising, but further studies must be conducted to confirm the long-term efficacy of this suture-button suspensionplasty.
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Affiliation(s)
- Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA.
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22
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Adams JE, Steinmann SP, Culp RW. Bone-preserving arthroscopic options for treatment of thumb basilar joint arthritis. Hand Clin 2011; 27:355-9. [PMID: 21871359 DOI: 10.1016/j.hcl.2011.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
While trapeziectomy with or without interposition arthroplasty and ligament reconstruction or suspensionplasty have been demonstrated to have a high rate of satisfactory outcomes, recent interest has focused on arthroscopy because of its perceived limited invasive nature as well as its versatility. In addition, using the arthroscope, other options are available that preserve all or part of the trapezium to limit subsidence of the thumb axis, preserve grip and pinch strength, and retain later options for joint reconstruction, should that become necessary.
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Affiliation(s)
- Julie E Adams
- Department of Orthopaedic Surgery, University of Minnesota, 2450 Riverside Avenue R 200, Minneapolis, MN 55454, USA.
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Suture button suspensionplasty after arthroscopic hemitrapeziectomy for treatment of thumb carpometacarpal arthritis. Arthroscopy 2010; 26:1395-403. [PMID: 20887938 DOI: 10.1016/j.arthro.2010.07.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 02/02/2023]
Abstract
A myriad of techniques for reconstruction of the arthritic thumb carpometacarpal joint have been described. In the modern era, there has been a push, driven by both clinicians and patients, for more rapid rehabilitation after these procedures. A majority of the historically described techniques require pinning of the thumb ray for 4 weeks. Suture button placement between the thumb and index ray metacarpals has been shown in biomechanical studies to effectively resist subsidence of the thumb ray. We describe a novel technique of using a suture button for suspensionplasty of the thumb ray after arthroscopic partial trapeziectomy. This technique allows for early mobilization and may offer a potential improvement on current techniques. Early results of use of this technique are encouraging, but well-conducted follow-up studies are necessary.
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Arthroscopic debridement and synovectomy for treating basal joint arthritis. Arthroscopy 2010; 26:34-40. [PMID: 20117625 DOI: 10.1016/j.arthro.2009.06.031] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Revised: 06/26/2009] [Accepted: 06/29/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether arthroscopic debridement and synovectomy of the thumb carpometacarpal joint improves subjective and objective outcomes in patients with stage I and stage II basal joint arthritis. METHODS Twenty-three patients with stage I or stage II basal joint arthritis were treated with arthroscopic synovectomy and joint debridement. Twenty-one age- and gender-matched patients were treated with additional forms of nonoperative therapy (control group). Change in visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH), and subjective scores and change in pinch strength were evaluated 12 months after treatment. RESULTS The pretreatment mean VAS, DASH, and subjective scores for the surgical and control groups were 7.7 and 7.5, respectively (P = .3); 55.6 and 54.4, respectively (P = .3); and 4 and 4, respectively (P = .9). At follow-up, the mean VAS, DASH, and subjective scores for the surgical and control groups were 2.7 and 7.3, respectively (P < .001); 26 and 53.1, respectively (P < .001); and 1.8 and 3.8, respectively (P < .001). At follow-up, mean pinch strength for the surgical and control groups was 6.2 +/- 1.3 kg and 4.9 +/- 1.1 kg, respectively (P < .001). Eighty-three percent of the surgical patients reported their result as either good or excellent. There were no significant complications. CONCLUSIONS This study shows that arthroscopic debridement and synovectomy improve pain scores, functional scores, subjective outcome, and pinch strength more so than traditional nonoperative therapy.
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DelSignore JL, Accardi KZ. Suture suspension arthroplasty technique for basal joint arthritis reconstruction. Tech Hand Up Extrem Surg 2009; 13:166-172. [PMID: 19956040 DOI: 10.1097/bth.0b013e3181b4c388] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Numerous techniques have been developed to address thumb basal joint arthritis. Many techniques include trapeziectomy with ligament reconstruction, most commonly performed by sacrificing a tendon that is used for ligament reconstruction and stabilization of the first metacarpal, with or without pin fixation. Harvesting a tendon for use in basal joint reconstruction is time-consuming and not without potential complications. Redirecting tendons via drill holes or anchoring tendons via suture anchors adds additional morbidity and time to the operative procedures. The authors introduce a novel technique of basal joint reconstruction, employing suture suspension for maintenance of joint arthroplasty space and stabilization of the base of the first metacarpal.
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Affiliation(s)
- Jeanne L DelSignore
- University of Rochester School of Medicine, Hand Surgery Associates, L.L.P., Rochester, NY 14625, USA.
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