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Mitchell AR, Kerkhof FD, Wadhwa H, Ladd AL. The Role of the Flexor Carpi Radialis Groove in Trapeziometacarpal Osteoarthritis. Hand (N Y) 2024; 19:90-95. [PMID: 36050929 PMCID: PMC10786103 DOI: 10.1177/15589447221120844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thumb carpometacarpal (CMC) osteoarthritis (OA) is a common condition. The contribution of surrounding ligaments and tendons to the stability of the CMC joint is likely altered in OA. The flexor carpi radialis (FCR) tendon runs in the trapezial FCR groove and is often noted to be frayed during CMC arthroplasty. We hypothesized that decreased integrity of the FCR tendon is related to FCR groove morphology and is associated with increased severity of CMC OA. METHODS We examined 3-dimensional surface models based on computed tomography (CT) scans of explanted trapezia from patients who underwent thumb CMC arthroplasty. Fraying of the FCR tendon was rated intraoperatively. Measurements were taken of the FCR groove to evaluate its morphology. Preoperative thumb CMC radiographs for each patient were scored using the modified Eaton classification system and the Thumb Osteoarthritis Index. Differences in the tendon groups were examined, and multivariable linear regression models were used to test the association between tendon group and FCR groove measurement. RESULTS There were 136 patients who were categorized into 4 tendon groups: intact, minor fraying, fraying, and ruptured. There were no differences between the tendon groups on any measures. CONCLUSIONS Our findings do not demonstrate a significant influence of FCR groove morphology on FCR tendon fraying in CMC arthroplasty patients. We also did not find a significant association between the FCR tendon state and degree of radiographic CMC OA. Further studies should investigate the in vivo FCR tendon to evaluate its tearing and inflammation in relation to basilar thumb pain.
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Shonuga O, Nicholson K, Abboudi J, Gallant G, Jones C, Kirkpatrick W, Liss F, Takei RR, Wang M, Ilyas AM. Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition. Hand (N Y) 2023; 18:98-104. [PMID: 33789518 PMCID: PMC9806544 DOI: 10.1177/1558944721994227] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Thumb carpometacarpal (CMC) joint arthroplasty is a common procedure in the surgical management of symptomatic thumb basal joint arthritis. Following trapeziectomy, a number of suspensionplasty techniques are often used, but limited comparative evidence exists between these techniques. The central aim of this study was to prospectively compare the outcomes of 2 suspensionplasty techniques following trapeziectomy: suture button (TightRope) versus ligament reconstruction and tendon interposition (LRTI). METHODS Prospective data were collected on 112 consecutive patients with Eaton stage III-IV thumb CMC arthritis who underwent open trapeziectomy and suspensionplasty. There were 53 LRTI and 59 TightRope suspensionplasty procedures. Outcomes were measured using the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, Visual Analogue Scale (VAS) for pain, radiographic analysis, and lateral pinch strength. Patient demographic data and complications were also recorded. RESULTS Patients undergoing TightRope suspensionplasty had significantly higher trapeziometacarpal index and thus less subsidence than the LRTI group at 2 weeks (0.22 vs 0.17 [P < .0001]) and 3 months (0.17 vs 0.15 [P < .05]) postoperatively. TightRope suspensionplasty also had a significantly lower QuickDASH score at 2 weeks (64.7 vs 74.6 [P < .05]), 3 months (20.7 vs 32.5 [P < .05]), and 1 year postoperatively (7.57 vs 21.5 [P < .05]) compared with the LRTI group. However, there was no difference in VAS pain, lateral pinch strength, reoperation, or complications at any time point between groups. CONCLUSIONS Thumb CMC joint arthroplasty performed with a TightRope suspensionplasty versus LRTI yielded short-term improved resistance to subsidence, long-term greater improvement in clinical outcome by QuickDASH, and no difference in pain or complication rates.
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Affiliation(s)
- Owolabi Shonuga
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - Kristen Nicholson
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - Jack Abboudi
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - Gregory Gallant
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - Christopher Jones
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | | | - Frederic Liss
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - R. Robert Takei
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - Mark Wang
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
| | - Asif M. Ilyas
- Rothman Institute of Thomas Jefferson
University, Philadelphia, PA, USA
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Update on Thumb Basal Joint Arthritis Surgery. Plast Reconstr Surg 2021; 148:811e-824e. [PMID: 34705791 DOI: 10.1097/prs.0000000000008487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Comprehend anatomy and biomechanics of the normal and arthritic trapeziometacarpal joint. 2. Evaluate best evidence for diagnosis and for operative and nonoperative treatment of thumb osteoarthritis. 3. Understand treatment pitfalls of basilar joint arthritis and complication avoidance. SUMMARY Articular and ligamentous anatomy of the trapeziometacarpal joint enables complex motions. Disability from arthritis, common at the trapeziometacarpal joint, is debilitating. Furthering the understanding of how trapeziometacarpal arthritis develops can improve treatment. The authors provide current best evidence for diagnosis and treatment of basilar joint arthritis. Pitfalls in treatment are discussed.
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Langer MF, Grünert JG, Unglaub F, Richter M, van Schoonhoven J, Oeckenpöhler S. [Resection arthoplasty of the trapezium with ligament reconstruction and tendon interposition and variations]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2021; 33:183-199. [PMID: 34106290 DOI: 10.1007/s00064-021-00715-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/11/2021] [Accepted: 02/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Creation of a pain-free, flexible and stable (pseudo) joint between the carpus and the base of the 1st metacarpal bone. INDICATIONS Painful carpometacarpal (CMC)‑I joint due to primary or secondary osteoarthritis, CMC‑I instability. CONTRAINDICATIONS Carpal instability, local infection, tumors. SURGICAL TECHNIQUE Resection of the trapezium (and of the arthritic joint surfaces in CMC‑I and STT [scaphoid-trapezium-trapezoid-joint]), stabilization of the base of the 1st metacarpal bone by suspension with a distally pedicled strip of the flexor carpi radialis tendon or variants thereof. POSTOPERATIVE MANAGEMENT Immobilization in a splint for 3-5 weeks, followed by hand therapy. RESULTS Worldwide for almost 40 years, regardless of the exact technique, almost always (90%) significant pain reduction, increased strength in the grip and slightly less in the pinch grip, very good mobility, 85-95% very satisfied patients and very good long-term results.
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Affiliation(s)
- Martin Franz Langer
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland.
| | | | - Frank Unglaub
- Vulpiusklinik Bad Rappenau, Bad Rappenau, Deutschland
| | - Martin Richter
- Malteser Krankenhaus Bonn/Rhein-Sieg, Bonn/Rhein-Sieg, Deutschland
| | | | - Simon Oeckenpöhler
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Waldeyerstr. 1, 48149, Münster, Deutschland
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Scaphometacarpal arthrodesis with autologous structural bone graft as a salvage procedure after failed trapeziectomy – Surgical technique and initial results. HAND SURGERY & REHABILITATION 2020; 39:539-544. [DOI: 10.1016/j.hansur.2020.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 11/23/2022]
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Earp BE, Mora AN, Silver JA, Benavent KA, Blazar PE. Intermediate-Term Outcomes of Trapeziectomy With a Modified Abductor Pollicis Longus Suspension Arthroplasty. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2019. [DOI: 10.1016/j.jhsg.2019.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Grasu BL, Trontis AJ, Parks BG, Wittstadt RA. Four-Strand Versus 2-Strand Suture-Button Constructs in First Carpometacarpal Arthroplasty: A Biomechanical Study. Hand (N Y) 2019; 14:626-631. [PMID: 29671348 PMCID: PMC6759960 DOI: 10.1177/1558944718769665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Suture-button fixation is an alternative to no fixation, first metacarpal distraction techniques, or Kirschner wire fixation after trapeziectomy in treatment of first carpometacarpal (CMC) arthritis. A 4-strand suture-button construct requires a 2.7-mm tunnel, whereas a 2-strand construct requires a 1.1-mm tunnel, potentially decreasing the risk of metacarpal fracture. We compared stability and failure criteria of 4-strand versus 2-strand construct in a biomechanical model of first CMC joint arthroplasty. Methods: Ten fresh-frozen matched pairs of human cadaveric hands were randomized to receive a 4-strand or 2-strand suture-button device. Trapeziectomy and fluoroscopic measurement of the fixed posttrapeziectomy space was performed before and after cycling 1000 times at 0.2 Hz in a custom loading device. The constructs were loaded to failure and failure mechanism was noted. Results: There was no significant difference between the groups in unfixed posttrapeziectomy, fixed precyclic loading, or postcyclic loading height. No difference in pinch pressure was found in any group. No difference in load to failure was observed. The 4-strand device failed through the first ray in 8 of 11 specimens, and the suture of the 2-strand device failed in 5 of 9 specimens. Conclusions: The 4-strand and 2-strand suture-button constructs provide comparable biomechanical stability for first CMC arthroplasty. If construct stability is similar between these procedures, the smaller tunnel used with the 2-strand construct may offer an advantage.
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Affiliation(s)
| | | | | | - Raymond A. Wittstadt
- The Curtis National Hand Center,
Baltimore, MD, USA,Raymond A. Wittstadt, c/o Anne Rupert
Mattson, Editor, The Curtis National Hand Center, MedStar Union Memorial
Hospital, 3333 North Calvert Street, #200, Baltimore, MD 21218, USA.
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Hess DE, Drace P, Franco MJ, Chhabra AB. Failed Thumb Carpometacarpal Arthroplasty: Common Etiologies and Surgical Options for Revision. J Hand Surg Am 2018; 43:844-852. [PMID: 29934082 DOI: 10.1016/j.jhsa.2018.03.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/30/2018] [Indexed: 02/02/2023]
Abstract
Carpometacarpal (CMC) arthroplasty surgery, although modifications have occurred over time, continues to be commonly performed and has provided patients with their desired pain relief and return of function. The complications of primary surgery, although relatively rare, can present in various clinical ways. An understanding of the underlying anatomy, pathology of coexisting conditions, and specific techniques used in the primary surgery is required to make the best recommendation for a patient with residual pain following primary CMC arthroplasty. The purpose of this review is to provide insights into the history of CMC arthroplasty and reasons for failure and to offer an algorithmic treatment approach for the clinical problem of persistent postoperative symptoms.
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Affiliation(s)
- Daniel E Hess
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Patricia Drace
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA
| | - Michael J Franco
- Department of Plastic and Reconstructive Surgery, Cooper University Hospital, Camden, NJ
| | - A Bobby Chhabra
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA.
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Sadhu A, Calfee RP, Guthrie A, Wall LB. Revision Ligament Reconstruction Tendon Interposition for Trapeziometacarpal Arthritis: A Case-Control Investigation. J Hand Surg Am 2016; 41:1114-1121. [PMID: 27751779 PMCID: PMC5138108 DOI: 10.1016/j.jhsa.2016.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/16/2016] [Accepted: 09/09/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the null hypothesis that there is no difference in patient-reported and objective outcomes of revision ligament reconstruction and tendon interposition (LRTI) compared with primary LRTI. METHODS This case-control investigation enrolled 10 patients who had undergone revision LRTI at a tertiary care center. All patients had previously undergone primary trapeziectomy with LRTI. Patients with a minimum of 2 years' follow-up were eligible. All patients completed an in-office study evaluation. Controls (treated only with primary LRTI) were matched from our practice to reach a 1:2 case-control ratio. Outcome measures included Michigan Hand Questionnaire (primary outcome), Quick-Disability of the Arm, Hand, and Shoulder (QuickDASH) questionnaire, visual analog scale (VAS) for pain and improvement, and physical examination. Statistical analyses were conducted to compare patient groups. RESULTS Patients who underwent revision LRTI reported significantly worse outcomes on all measured standardized questionnaires compared with primary patients. The Michigan Hand Questionnaire indicated worse overall outcomes (54 vs 79) as well as worse pain, appearance, and ability to complete activities of daily living. Compared with those who did not undergo revision LRTI, patients who did also reported more impairment (Quick-Disability of the Arm, Hand, and Shoulder, 47 vs 23), greater pain (VAS pain, 6.3 vs 1), and less improvement after surgery (VAS improvement, 2.7 vs 7.9). There was also a significantly higher rate of patient-reported depression in the revision LRTI group (50% vs 10% of patients treated with primary LRTI). We did not find a significant difference in objective outcomes of pinch strength, grip strength, and thumb palmar abduction between the 2 groups. CONCLUSION After revision LRTI, patient-reported outcomes indicate worse perceived function and greater pain than are expected following primary LRTI despite similar motion and strength. Revision surgery can be offered in the setting of persistent or recurrent symptoms, but patients should be counseled that improvement of symptoms is unpredictable. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Anita Sadhu
- Washington University in St. Louis Department of Orthopedic Surgery, 425 S. Euclid Avenue Suite 5505, St. Louis, MO 63110,
| | - Ryan P. Calfee
- Washington University in St. Louis Department of Orthopedic Surgery, 425 S. Euclid Avenue Suite 5505, St. Louis, MO 63110,
| | - Andre Guthrie
- Washington University in St. Louis Department of Orthopedic Surgery, 425 S. Euclid Avenue Suite 5505, St. Louis, MO 63110,
| | - Lindley B. Wall
- Washington University in St. Louis Department of Orthopedic Surgery, 425 S. Euclid Avenue Suite 5505, St. Louis, MO 63110
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Imaging and management of thumb carpometacarpal joint osteoarthritis. Skeletal Radiol 2015; 44:165-77. [PMID: 25209021 DOI: 10.1007/s00256-014-1997-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/20/2014] [Accepted: 08/21/2014] [Indexed: 02/02/2023]
Abstract
Primary osteoarthritis (OA) involving the thumb carpometacarpal (CMC) joint is a common and frequently debilitating disease. Clinical examination and radiographs are usually sufficient for diagnosis; however, familiarity with the cross-sectional anatomy is useful for diagnosis of this condition. The most widely used classification system for the radiographic staging of thumb carpometacarpal joint OA was first presented by Eaton and Littler, ranging from mild (stages I and II) to severe (stage IV) disease. If conservative treatment fails, surgical treatment is considered. A variety of surgical techniques have been developed and implemented for the management of this pervasive and disabling condition. The purpose of this article is to review the anatomy of the basal joints of the thumb, pathophysiology, preoperative imaging, and various surgical techniques that are utilized in the treatment of OA of the basal joints of the thumb with emphasis on normal postoperative radiographic findings and possible postoperative complications.
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Luong DH, Smith J, Bianchi S. Flexor carpi radialis tendon ultrasound pictorial essay. Skeletal Radiol 2014; 43:745-60. [PMID: 24658615 DOI: 10.1007/s00256-014-1846-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/02/2014] [Accepted: 02/05/2014] [Indexed: 02/02/2023]
Abstract
Disorders of the flexor carpi radialis tendon (FCRt) are often missed even though they are a relatively frequent cause of volar radial wrist pain. They can manifest as tenosynovitis, tendinopathy, synovial sheath cysts with or without scaphoid-trapezoid-trapezium (STT) joint pathology, and partial or complete rupture. Because FCRt disorders often present with non-specific symptoms and a non-diagnostic clinical examination, imaging is often necessary for accurate evaluation and therapeutic planning. Conventional radiography provides good visualization of the neighboring bones and joints, as well as rare intratendinous calcifications. MRI enables evaluation of the FCRt and adjacent anatomical structures with excellent tissue resolution. In comparison, ultrasound (US) evaluation of the FCRt is less commonly described in the radiology literature, despite its affordability, exquisite soft tissue resolution, and the advantages of quick, dynamic diagnostic imaging. This pictorial essay describes and demonstrates the normal anatomy of the FCRt, its US examination technique and normal US appearance, and US findings of clinically relevant FCRt disorders.
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