Mean 5-Year Follow-up for Suture Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Joint Osteoarthritis

Patient Outcomes of Thumb Arthroplasty Using a Hybrid Technique for Severe Osteoarthritis

Background

Patient-based evaluations effectively quantify a patient's perception of the impact of a disorder and surgical results. With multiple surgical techniques for thumb carpometacarpal (CMC) arthritis, we propose a hybrid technique combining trapeziectomy with ligament reconstruction and tendon interposition and suture button suspensionplasty to evaluate its statistical significance and clinical relevance.

Methods

We conducted a retrospective study on patients receiving primary surgery of combining trapeziectomy with ligament reconstruction and tendon interposition and suture button suspensionoplasty for advanced osteoarthritis from 2017 to 2023. Patient-reported outcome measurements (PROMs) including Quick Disabilities of the Arm, Shoulder and Hand, pain visual analog scale (VAS), and single assessment numeric evaluation (SANE) were analyzed at 2 years. Receiver operating characteristic curves derived clinically significant outcome (CSO) thresholds of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS).

Results

PROMs from 32 hands (31 patients) exhibited significant difference at 2 years postoperatively. CSO thresholds of MCID were 18.2, 1, and 70 for Quick Disabilities of the Arm, Shoulder and Hand, VAS, and SANE, respectively. SCB values were 15.9, 1, and 75, and PASS were 18.2, 0, and 80. More than 80% of patients achieved CSO thresholds in all 3 scores, except for PASS in VAS and SANE scores, with 70% and 72% of patients reaching these cutoff values.

Conclusions

Significant improved difference were observed in 2-year PROMs, with most patients achieving MCID and SCB but not PASS for VAS and SANE scores. Continued observation of patients' perspectives on this surgery is warranted.

Stabilization of the Thumb Carpometacarpal Joint Utilizing a Minimally Invasive Approach: A Novel Technique

Treatment of symptomatic thumb carpometacarpal (CMC) joint synovitis can be challenging. Surgical options in these patients are often limited due to the patient's youth and lack of arthrosis. One of the most commonly used techniques involves the use of the flexor carpi radialis to reconstruct the ligamentous complex of the thumb CMC joint. This technique is technically challenging and involves a wide exposure to the CMC joint. Furthermore, outcomes data on this technique are relatively lacking. We propose a novel minimally invasive technique to confer stability to the thumb CMC joint in the setting of persistent subluxation/synovitis using the Arthrex MiniTightrope system. Our clinical results are encouraging at mean 24 months postoperative with nearly all patients experiencing both statistically and clinically meaningful improvements in QuickDASH and Visual Analog Scale pain scores.

Magnetic Resonance Imaging of Thumb Carpometacarpal Arthroplasty: Preoperative Evaluation and Postoperative Imaging

In this review we discuss the magnetic resonance imaging (MRI) appearance of thumb carpometacarpal (CMC) arthroplasty, both the preoperative evaluation and particularly the postoperative MRI of different surgical options for patients with advanced degenerative disease of the basal joint of the thumb. The first CMC joint is one of the most frequently involved articulations in the hand and wrist in the setting of degenerative osteoarthrosis and certainly a pain generator and important cause of disability due to its significant impact on hand function. It is the most common joint for which surgery is sought in the wrist. Radiologists interpreting imaging studies of patients with first CMC joint arthroplasty must be familiar with the normal and abnormal preoperative appearance of the thumb basal joint. Moreover, knowledge of the normal postoperative MRI findings, as well as the appearance of patterns of failure and complications, is of paramount importance.

An Updated Survey of Trends in the Surgical Management of Thumb Carpometacarpal Arthritis - The Increasing Popularity of the Suture Suspension Arthroplasty

Background: The purpose of this study was to conduct an updated survey of American Society for Surgery of the Hand (ASSH) membership to evaluate current preferences for surgical management of thumb CMC arthritis. Past surveys have demonstrated LRTI to be the most preferred surgical technique. We hypothesised that current surgical preferences for thumb CMC arthritis have changed over the last several years due to rising popularity of high-strength suture implants. Methods: A 22-question survey inquired about the preferences for the surgical management of basal joint arthritis and was sent to the ASSH membership. Descriptive statistics were calculated on all survey questions. Chi-squared analysis was used to compare differences in thumb CMC arthroplasty preferences across respondents. Results: A total of 1,499 responses were available for analysis, yielding a response rate of 29.9%. For surgical management of basal joint arthritis in the primary setting, the largest percentage of respondents preferred open trapeziectomy with suture suspension arthroplasty (39.2%); amongst them, over half (56%) used a high-strength suture implant. This was followed by open trapeziectomy with LRTI (38.3%). In the revision setting, most respondents preferred open trapeziectomy with suture suspension arthroplasty (53.5%), followed by LRTI (24.6%). In determining the choice of procedure, respondents felt some form of metacarpal suspension and implant cost to be more important factors than ligament reconstruction and interposition. A higher proportion of international members (16.2%) utilised implant arthroplasty than US/Canadian members (1.1%; p < 0.01). Conclusions: Past surveys have demonstrated LRTI to be the most preferred surgical technique. The current survey demonstrates open trapeziectomy and suture suspension arthroplasty, especially using high-strength suture implants, gaining popularity amongst surgeons, while open trapeziectomy and LRTI decreasing in preference. Suture suspension arthroplasty is now the preferred surgical technique in both the primary and revision setting. Level of Evidence: Level IV (Therapeutic).

A Preliminary Study of the Impact of Intensive Hand Therapy after Arthroscopic Partial Trapeziectomy with Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis

Background: Thumb carpometacarpal (CMC) arthritis is a painful and debilitating condition, which in severe cases may be treated by surgery. Previous studies have emphasised the importance of rehabilitation following surgery to achieve optimal results. This study aimed to investigate whether intensive hand therapy is effective in improving hand functions after arthroscopic partial trapeziectomy with suture-button (SB) suspensionplasty in patients with thumb CMC arthritis. Methods: This was a retrospective observational study that used non-randomised historical controls. Patients who underwent arthroscopic partial trapeziectomy with SB suspensionplasty were divided into two groups according to whether they had postoperative hand therapy or not (hand therapy group, n = 12; no hand therapy group, n = 11). CMC joint pain, range of motion (ROM), grip and pinch strength in the operative side and Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score were compared before surgery and at the final follow-up for each group. Results: CMC joint pain, ROM and QuickDASH scores significantly improved following surgery, in both groups. Conversely, postoperative grip and pinch strength only increased significantly in the hand therapy group (grip strength: effect size = 0.36, pinch strength: effect size = 0.44). Conclusions: This study demonstrates that early-stage intensive hand therapy is an effective intervention after arthroscopic partial trapeziectomy with SB suspensionplasty, specifically for improving grip and pinch strength. Level of Evidence: Level III (Therapeutic).

What Factors Influence Variability in Thumb Carpometacarpal Arthroplasty Care? A Survey of ASSH Members

BACKGROUND

The purpose of this study was to gather information regarding current practices in the care of carpometacarpal (CMC) arthroplasty including the use of hand therapy, immobilization, and surgical technique, and to determine which factors influence these patterns.

METHODS

We conducted a survey from February 24, 2022, through March 26, 2022, of 3648 currently practicing members of the American Society for Surgery of the Hand. We developed an 11-item questionnaire that contained questions about surgical technique, immobilization, and postoperative therapy utilization. Results were analyzed using chi-square analysis and a Bonferroni correction was applied to account for multiple comparisons. Statistical significance was set at a P-value of less than .05.

RESULTS

A total of 811 hand surgeons completed the survey (22% response rate). Surgeons who are employed by the same medical center as their hand therapist use more in-person hand therapy than surgeons with other types of business relationships. Surgeons with more than 25 years of experience are less likely to recommend therapy routinely, more likely to use ligament reconstruction and tendon interposition, and less likely to be an employee of the same medical center as their hand therapist. The length of immobilization and the time at which hand therapy began were related to surgical technique.

CONCLUSIONS

Variability in hand therapy usage after CMC arthroplasty is at least partially explained by business relationships with hand therapists and surgeon experience. Variability in the length of immobilization and the beginning of hand therapy postoperatively was more associated with surgical technique.

Diagnostic and treatment recommendations for recurrent or persistent symptoms after trapeziectomy: a Delphi study

The aim of this Delphi study was to provide a diagnostic and treatment algorithm for patients with persistent or recurrent symptoms after trapeziometacarpal joint resection arthroplasty. Three Delphi rounds were conducted in which surveys were sent to 182 experienced hand surgeons worldwide. Responses were received from 140 participants. A consensus threshold was set at 67% agreement. Diagnostic tools and treatment approaches for six common revision scenarios achieved consensus. Radiographs are appropriate as primary (97%) and CT scans as secondary (76%) diagnostic tools. For scaphometacarpal impingement, 67% of respondents agreed that revision interposition is appropriate, with 93% recommending autologous tendon for the interposition. Additional suspension was considered appropriate by 68% of the participants. The diagnostic and treatment algorithm can help the surgeon to identify the reason for persistent symptoms after trapeziometacarpal joint resection arthroplasty and to choose an appropriate treatment strategy.Level of evidence: V.

Mid-Term Outcomes Following Trapeziectomy With Suture Suspensionplasty for Thumb Carpometacarpal Joint Osteoarthritis

PURPOSE

In the treatment of symptomatic thumb carpometacarpal joint arthritis, numerous techniques have been used to maintain the trapezial space following trapeziectomy. The purpose of this study was to report the clinical and radiographic outcomes of the suture suspensionplasty technique. The hypothesis was that suture suspensionplasty would have similar clinical and radiographic outcomes compared with other techniques aimed at maintaining the trapezial space following trapeziectomy.

METHODS

Data were collected on 42 patients following trapeziectomy with suture suspensionplasty for symptomatic Eaton stage II-IV carpometacarpal osteoarthritis at an average follow-up of 2.1 years. Outcomes included the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, visual analog scale for pain, radiographic analysis of subsidence, and physical examination of lateral pinch strength and thumb opposition.

RESULTS

Radiographs demonstrated that 42% of the trapezial space was maintained at 2.1 years following trapeziectomy with suture suspensionplasty. Median postoperative QuickDASH scores were 3.4 (first quartile, 0; third quartile, 15.9), which is consistent with or better than normative values in the population. Median postoperative visual analog scale scores were 0 (first quartile, 0; third quartile, 0) with good postoperative thumb opposition and pinch strength.

CONCLUSIONS

Patients who underwent trapeziectomy with suture suspensionplasty had similar functional and radiographic outcomes at an average of 2.1 years after surgery compared with other techniques used for treatment of symptomatic thumb carpometacarpal joint arthritis.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

A Prospective Randomized Pilot Study: One-Year Outcomes of Ligament Reconstruction Tendon Interposition Versus Suture Tape Suspensionplasty for Thumb Carpometacarpal Joint Arthritis

PURPOSE

We performed a randomized controlled trial assessing patient-reported outcome measures following trapeziectomy with ligament reconstruction and tendon interposition (LRTI) or suture tape suspensionplasty (STS) for treatment of thumb carpometacarpal joint osteoarthritis.

METHODS

Patients undergoing surgery for thumb carpometacarpal joint osteoarthritis were prospectively randomized to LRTI or STS. Outcome measures were collected at 2 weeks, 4 weeks, 3 months, and 1 year and included visual analog scale pain, Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity, return to work/activity, range of motion, grip/pinch strength, and complications.

RESULTS

Thirty-one patients (32 thumbs) were randomized from 51 patients offered participation over two years. One-year follow-up was 97%. Both groups had a decrease in visual analog scale pain scores at all postoperative time points. The trajectory of postoperative Patient-Reported Outcomes Measurement Information System Upper Extremity scores was similar, and both groups achieved the meaningful clinically important difference for improvement in PROMIS Upper Extremity by three months. Grip strength was substantially increased in both groups at one year. Return to work/activity and surgical complications favored the LRTI group.

CONCLUSIONS

Our study did not suggest any clinically relevant differences in the postoperative patient-reported outcome measures or objective clinical measurements between LRTI and STS, although LRTI patients had a faster return to work/activity and lower complication rates.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IIB.

Computed Tomography Investigation of First Metacarpal Subsidence After Suture Button Suspensionplasty: A Report of Two Cases

First metacarpal subsidence often occurs after suture button suspensionplasty (SBS) for first carpometacarpal joint arthritis. In this study, we describe computed tomography (CT) findings in two cases of first metacarpal subsidence after SBS. Case 1 was a 51-year-old right-handed male. At the final follow-up two years post-SBS, no noticeable thumb shortening was observed. CT imaging at the last follow-up showed a slight expansion of the hole in the first and second metacarpals where the suture had passed. Case 2 was a 58-year-old right-handed male. Thumb shortening was noticed three months and three weeks after SBS. At the final follow-up, two years and seven months post-surgery, CT imaging revealed significant expansion of the hole in a conical shape in the second metacarpal where the suture had passed. Our findings suggest that the expansion of the foramen where the suture passed through the metacarpals may contribute to the first metacarpal subsidence after the surgery.

Arthroscopic debridement, synovectomy, and thermal shrinkage for basal joint arthritis

BACKGROUND

Ligamentous laxity, cartilage wear, and diffuse synovitis are frequently seen in thumb basal joint arthritis. Although these degenerative changes may be mild for the majority, they have the potential to cause discomfort during movement and compromised hand function. This study assesses the long-term outcomes of arthroscopic debridement, synovectomy, and thermal shrinkage in managing early-stage basal joint arthritis.

METHODS

We retrospectively reviewed patients with basal joint arthritis who underwent arthroscopic debridement, synovectomy, and thermal shrinkage between November 2010 and January 2021 by a single surgeon at our medical institute. We assessed functional outcomes, thumb range of motion, perioperative nonsteroidal anti-inflammatory drug (NSAID) use, return to work and satisfaction level.

RESULTS

A total of 12 patients (13 hands), with a mean follow-up of 72 months, were included in this study. Significant improvements were observed in pain scores and functional outcomes, along with a reduction in postoperative NSAID use. Patients also reported a relatively quick return to work and a high satisfaction level.

CONCLUSION

The study highlights the benefits of arthroscopic intervention, providing a minimally invasive approach with favorable long-term outcomes for patients with symptomatic basal joint arthritis.

Reoperation Rate Following Thumb Basal Joint Arthroplasty: A Minimum Follow-Up Period of 5 Years

Purpose

Thumb basal joint arthroplasty (BJA) performed for thumb basal joint arthritis is associated with high patient satisfaction. However, complications requiring reoperation occur, with a previously reported early reoperation rate (within 2 years) of 1.5%. The purpose of this study was to determine the risk of and reasons for reoperation in the intermediate term, defined as within 5 years of the index surgery.

Methods

All cases of primary thumb BJA performed from 2014 to 2016 at a single private academic center were reviewed. For cases requiring reoperation, data regarding index surgical technique, reason for reoperation, time to reoperation, and reoperation technique were collected. Risk of reoperation (return to the operating room for any reason) and risk of revision arthroplasty (revision surgery for symptomatic subsidence or instability) within 5 years of the index surgery were calculated.

Results

A total of 686 primary thumb BJAs were performed in 637 patients. Risk of reoperation for any reason was 2.0% (14/686), and risk of revision arthroplasty for symptomatic subsidence or instability was 0.6% (4/686) within 5 years of surgery. The mean time between the index surgery and reoperation was 10.3 months (range, 16 days to 4.6 years) for all cases; however, for revision arthroplasty, the mean time was 9.6 months (range, 3.9-14.3 months).

Conclusions

The intermediate term (5 years minimum) rate of reoperation following thumb BJA for any reason was 2%, with only approximately one-fourth of reoperation cases requiring revision arthroplasty for symptomatic subsidence or instability. These data may provide useful information in the counseling of patients considering thumb BJA surgery.

Type of study/level of evidence

Prognostic IV.

Efficacy of Abductor Pollicis Longus Suspension Arthroplasty Combined With Mini TightRope for Osteoarthritis of Thumb Carpometacarpal Joint

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.

Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up

Purpose

Combined trapeziectomy and suture-button suspensionplasty (SBS) is a common and well-established surgical treatment for thumb carpometacarpal (CMC) osteoarthritis. Although short and mid-term follow-up studies have shown promising outcomes with patients retaining excellent range of motion and strength, long-term data are lacking. The aim of our study was to assess the long-term outcomes of patients who underwent SBS surgery for thumb CMC arthritis, with a minimum follow-up period of 10 years.

Methods

We evaluated 17 patients, at least 10 years after undergoing SBS surgery for thumb CMC arthritis. We measured grip and pinch strength, range of motion, and trapezial space height and compared it with the respective values measured on the routine postoperative 3-month follow-up visit. All patients have additionally completed the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire.

Results

The study included 11 women and 6 men with an average age of 60.3 ± 6.4 years and a mean follow-up of 137.4 ± 11.4 months after surgery. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 9 (range: 0-40.9) at the long-term follow-up, compared with 26.2 (range: 4.5-75) recorded 3 months after the surgery. Grip and pinch strengths were 116% and 111% of the 3-month postoperative value, respectively. Radial abduction and palmar abduction were 98% and 94% of the 3-month postoperative value, respectively. Kapandji scores were either equal or higher than the previously documented scores. Average height of the trapezial space was 69% of the previous postoperative measurement.

Conclusions

Our findings demonstrate that patients who underwent SBS surgery for thumb CMC osteoarthritis achieve excellent long-term outcomes by maintaining favorable subjective and objective results, despite some radiographic subsidence over time. These results indicate SBS to be an effective and durable technique for the long-term management of thumb CMC osteoarthritis.

Type of study/level of evidence

Therapeutic IV.

Early Thumb Carpometacarpal Subluxation Stabilized with a Mini TightRope: A Report of Two Cases

Two patients with thumb carpometacarpal instability were stabilized using a suture suspension device. Both patients had symptomatic thumb carpometacarpal instability in the setting of clinical hyperlaxity without known connective tissue disorder that was recalcitrant to nonsurgical modalities. Both patients had significant, lasting improvement in their pain and function with excellent radiographic outcomes. Suture suspension as a treatment for thumb carpometacarpal instability with an intact trapezium is an effective alternative to ligamentous reconstruction that avoids donor site morbidity and may have added benefit in patients with underlying ligamentous laxity.

Trapeziectomy with Ligament Reconstruction/ Suspensionplasty Compared to Suture Tape Suspensionplasty for the Surgical Treatment of Advanced Thumb Carpometacarpal Osteoarthritis

Purpose

Trapeziectomy with tendon reconstruction/suspensionplasty (TRS) is the most commonly performed surgical procedure in the United States for treatment of thumb carpometacarpal (CMC) osteoarthritis (OA). Trapeziectomy with suture tape suspensionplasty (STS) has been used recently at the study institution as an alternative surgical treatment option with perceived benefits of earlier return to function and reduced operative time. The purpose of this study was to compare patient outcomes following TRS versus STS for treatment of thumb CMC OA.

Methods

All patients who underwent primary, isolated TRS or STS for treatment of thumb CMC OA between 1/1/2014 and 9/1/2020 were analyzed. We assessed demographics and preoperative and postoperative patient-rated outcome scores including Patient-reported outcomes measurement information system scores as well as pain outcomes, satisfaction, and appearance at a mean of 2.6 years after surgery (minimum 6 months). Time to return to work and activities was compared between groups. Bivariate statistics compared outcomes between groups.

Results

Ninety-four patients were included in the final study cohort, of which 53 underwent TRS and 41 underwent STS. There were no differences in preoperative, postoperative, or final patient-rated outcome scores between groups. Patients reported high global and appearance satisfaction scores at final follow-up in both groups. Mean tourniquet time was 15 minutes (26%) shorter and return to work was on average 3 weeks faster for the STS group.

Conclusions

There were no differences in postoperative patient-rated outcome scores between the STS and TRS groups. The STS group had a shorter surgical time and faster return-to-work after surgery.

Type of study/level of evidence

Therapeutic III.

Radiographic Thumb Metacarpal Subsidence Following Ligament Reconstruction With Tendon Interposition and Suture-Only Suspension Arthroplasty in the Treatment of Basal Joint Arthritis

BACKGROUND

The thumb carpometacarpal (CMC) joint is a common source of osteoarthritis. Following trapeziectomy, ligament reconstruction with tendon interposition (LRTI) is considered a "gold standard" treatment, but suture-only suspension arthroplasty (SSA) has recently emerged as a simpler alternative. Currently, there is no objective radiographic study comparing subsidence following these 2 techniques.

METHODS

This study is a retrospective review of 23 patients (10 LRTI, 13 SSA) that had at least 6 months of radiographic follow-up following thumb CMC arthroplasty. Posteroanterior radiographs at a preoperative timepoint, and at the 2-week and greater than 6-month postoperative timepoints were evaluated for actual trapezial height, as well as trapezial height normalized to capitate, thumb metacarpal, and proximal phalangeal heights. Normalized trapezial heights were calculated, and preoperative values were compared with greater than 6-month postoperative values. In addition, actual and normalized trapezial heights following LRTI and SSA were compared at each timepoint.

RESULTS

Mean trapezial height decreased from approximately 12 to 5 mm (reduction of ~60%, P < .05) in both groups with no differences when comparing LRTI and SSA at each timepoint. All normalized trapezial heights revealed differences from preoperative to greater than 6-month postoperative timepoints, but no differences between LRTI and SSA.

CONCLUSIONS

Ligament reconstruction with tendon interposition and SSA exhibit equivalent actual and normalized trapezial heights over a greater than 6-month postoperative time course.

Systematic Comparison of Ligament Reconstruction With Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis

Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The primary purpose of this systematic review was to compare the subjective improvement in patient-reported outcomes in regard to disability for patients undergoing LRTI and SBS for trapeziometacarpal osteoarthritis. A secondary purpose was to compare the subjective improvement, objective outcome scores, and complication rates following both procedures. We performed a systematic review using PubMed, Scopus, and Embase to compare the clinical outcomes of LRTI and SBS. Inclusion criteria were level I-IV evidence articles reporting postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH scores. Study methodological quality, risk of bias, and recommendation strength were assessed. This systematic review included 31 studies for final analysis with 1289 thumbs undergoing LRTI (25 studies) and 113 thumbs undergoing SBS (6 studies). Both procedures demonstrated similar improvement in DASH and/or QuickDASH scores, while key pinch and grip strength inconsistently improved following both procedures. Complication rate was similar between the 2 procedures; LRTI 12% and SBS 13%. Although both LRTI and SBS seem to provide improved short-term patient-reported functional improvement and objective strength, there was significant heterogeneity within the included studies, and those studies discussing SBS were of lower quality evidence than those of LRTI. Thus, to truly delineate whether a difference exists between these 2 techniques for the treatment of first carpometacarpal joint arthritis, larger prospectively designed studies of high-quality evidence are necessary.

Transosseous Cannula Suture Suspensionplasty for Thumb Basal Joint Arthritis: A Novel Technique

The suture button (SB) suspension technique has become popular in the treatment of thumb basal joint arthritis, as it works as an internal mean for metacarpal stabilization, demonstrating good results with improvement in function and strength. The aim of our study is to describe a new transosseous suture suspensionplasty technique using a simple Ethibond #2 suture as a substitute for the suture button and to report the postoperative clinical outcomes. In this study, we included a total of 14 patients with 2 years follow-up. We evaluated patients with the use of the Disabilities of the Arm, Shoulder and Hand questionnaire, the Visual Analog Scale, the Kapandji test, and the key pinch strength. Patients treated with transosseous suture suspensionplasty demonstrated clinical improvement at an average follow-up of 24 months. No complications were noted immediately after the procedure or during the 2-year follow-up period.

Wide-Awake Local Anesthesia No Tourniquet for Rhizarthrosis Surgery: Technique and Experience for 16 Consecutive Cases

Since it was described, wide-awake local anaesthesia no tourniquet (WALANT) has gained popularity. Our department has started using WALANT for hand surgery with increasing complexity. We present our results with WALANT rhizarthrosis surgery, including prosthetic replacement, trapeziectomy with suture button suspensionplasty and revision surgery. A retrospective review of all rhizarthrosis procedures under WALANT was performed from April 2021 to July 2022. We included patients who fulfilled inclusion criteria and had adequate imaging and clinical follow-up. A satisfaction survey was performed by telephone. Surgical time, complications, conversion to conventional anesthesia, pain, anxiety and global satisfaction were recorded. Tumescent anesthesia is performed 20-25 minutes before surgery, and is performed in four or five strategic locations that allow adequate anesthesia and vasoconstriction for the procedure to be comfortably carried out. We observed a series of 16 sequential surgeries involving 14 patients. All were female with a mean age of 65 years. Fourteen cases were performed due to primary rhizarthrosis, eight trapeziectomies with suture button suspensionplasty, six prosthetic replacements, and two revision surgeries. One patient needed to be converted to conventional anaesthesia due to anxiety during the procedure. Mean procedure time was 73 minutes. There were no WALANT-related complications. Mean patient-reported satisfaction with the anesthetic technique was a 9 (on a scale from 1 to 10) and 100% of patients would choose to undergo surgery with WALANT anesthesia for a future procedure. We find it useful to actively engage the patients during surgery to keep them comfortable and also help the surgeons assess stability and functional results. After wound closure, the hand is shown to the patient and he performs various tasks. There is somewhat of a learning curve for rhizarthrosis surgery under WALANT; patient comfort can be achieved through an adequate anesthetic technique and reassurance before and during surgery. We recommend that the first few cases be done in the presence of an anesthesiologist and a fasting patient in case there is a need to convert to conventional anesthesia. Wide awake rhizarthrosis surgery, even revision surgery, is safe and pain-free. Patient-reported satisfaction is also high. The authors find that including patient participation in their own surgery might be promising for post-op rehabilitation. There are limitations in this study such as the absence of a control conventional anesthesia group, the satisfaction questionnaire was not done immediately post-operatively, as such, a memory bias cannot be excluded, and it is not yet validated for the Portuguese population.

Suspension arthroplasty using the palmaris longus tendon with a suture button for thumb trapeziometacarpal arthritis: a retrospective observational study

BACKGROUND

This study was performed to assess the clinical and radiographic results at a minimum of 2 years after ligament reconstruction suspension arthroplasty (LRSA) that comprised full trapeziectomy and suspensionplasty using the palmaris longus tendon and the Mini TightRope (Arthrex, Naples, FL) for advanced thumb carpometacarpal arthritis.

METHODS

We clinically and radiographically evaluated 26 thumbs in 26 patients who had undergone LRSA at least 2 years previously. The mean follow-up period was 35.9 months. We evaluated the subjective clinical outcomes (visual analogue scale and Quick Disabilities of the Arm, Shoulder, and Hand scores) and objective clinical outcomes (range of motion, pinch strength, grip strength, and trapezial space height ratio).

RESULTS

At the final follow-up evaluation, the mean visual analogue scale score was 11.1 (standard deviation (SD) 13.4) and the mean Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score was 9.39 (SD 10.1). The mean palmar and radial abduction were 62.3° (SD 11.8°) and 63.8° (SD 9.09°), respectively. The mean key pinch and grip strength were 3.92 (SD 1.07) kg and 19.7 (SD 7.77) kg, respectively. The mean trapezial space ratio was 0.21 (SD 0.10). The subjective clinical outcomes, range of motion, and pinch strength were significantly improved compared with preoperatively.

CONCLUSIONS

LRSA for advanced-stage thumb carpometacarpal osteoarthritis relieves pain, improves range of motion and strength, and obtains favourable subjective patient-reported clinical outcomes.

Clinical Results of Arthroscopic Partial Trapeziectomy With Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis

BACKGROUND

This study represents the clinical results, especially range of motion (ROM) improvement, of arthroscopic partial trapeziectomy with suture-button suspensionplasty for symptomatic grade II and III thumb carpometacarpal arthritis with a minimum 1-year follow-up.

METHODS

Thirty-two patients (mean: 67.5 years) with grade II and III thumb carpometacarpal arthritis treated with arthroscopic partial trapeziectomy with suture-button suspensionplasty were retrospectively followed up for at least 1 year. The physical assessments included ROM, pain visual analogue scale (VAS), strength, and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The physical variables were retrospectively compared before surgery and at the final follow-up.

RESULTS

Preoperative radial abduction and palmar abduction (45.4 ± 16.4° and 54.3 ± 13.9°, respectively) were significantly increased at the final follow-up (59.7 ± 16.9° and 65.5 ± 14.2°, respectively). Preoperative VAS score, pinch strength, and DASH score (70.5 ± 14.0, 57.2 ± 24.8% and 36.8 ± 14.8, respectively) were also significantly improved at the final follow-up (7.9 ± 9.1, 91.0 ± 39.6%, and 11.7 ± 10.5, respectively). Complications involved 1 case of irritation of the superficial branch of the radial nerve and 1 case of dystonia. Two suture-buttons were removed due to patient discomfort.

CONCLUSIONS

A significant increase in ROM and pain relief was obtained after suture-button suspensionplasty with arthroscopic partial trapeziectomy.

Radiographic Evaluation after Arthroscopic Partial Trapeziectomy with Suture-button Suspensionplasty for Thumb Carpometacarpal Arthritis

Arthroscopic partial trapeziectomy with suture-button suspensionplasty was developed for the surgical treatment of thumb carpometacarpal arthritis. However, the relationship between clinical results and radiographic evidence is unclear.

Methods

The authors retrospectively reviewed 33 consecutive patients who underwent arthroscopic partial trapeziectomy with suture-button suspensionplasty for thumb carpometacarpal arthritis between 2016 and 2021. Clinical and radiographic outcomes were recorded, and the correlations between them were evaluated.

Results

The average patient age at surgery was 69 years. Patient radiologic evidence was Eaton stage Ⅱ in three thumbs, Ⅲ in 25 thumbs, and Ⅳ in five thumbs. The average trapezial space ratio (TSR) was 0.36 immediately after the operation but declined to 0.32 after 6 months. In contrast, the average joint subluxation was reduced to 0.005 immediately after the operation compared with 0.28 before, and was maintained at 0.04 at final follow-up. A statically significant correlation was detected between grip strength and TSR (P = 0.03), and between pinch strength and TSR (P = 0.02). A significant correlation was detected between TSR and trapezium height (P = 0.0215), which remained after partial trapeziectomy. No correlation was detected between rope position and other clinical or radiographic scores.

Conclusions

Suture-button can have an effect on the medialization of the first metacarpal base. Excessive trapeziectomy can result in functional deficiency of the thumb through metacarpal subsidence, which potentially causes loss of grip and pinch strength.

Mini TightRope Suspension Allows for Accelerated Rehabilitation following Ligament Reconstruction Interposition Arthroplasty of the Basal Joint of the Thumb

Introduction  Surgical treatment of thumb trapeziometacarpal osteoarthritis usually involves 4 to 8 weeks of postoperative casting and splinting followed by varying mobilization protocols. Suspension arthroplasty has been described as an alternative to allow earlier range of motion exercises. The purpose of this study was to compare patient-reported outcomes (PRO) when adding a two-string suture-button suspension arthroplasty (Mini TightRope, MTR) to our usual procedure of ligament reconstruction and tendon interposition (LRTI), allowing early mobilization. Can we allow early mobilization using this technique without jeopardizing the PRO results at the 1 year follow-up and without an increased risk of complication? Materials and Methods  A prospective study using the MTR system (Arthrex) as a suture-button suspensionplasty was conducted. Twelve patients (MTR group) and 36 historical patients (LRTI alone) were included. Results  At 12 months, the median value for quick disabilities of the arm, shoulder, and hand was 11.3 (range, 0-43.2) in the MTR group and 13.6 (range, 0-88.6) in the LRTI group, resulting in similar improvements, p  = 0.46. One in twelve patients in the MTR group was dissatisfied and 9 in 36 in the LRTI group were dissatisfied, p  = 0.41. No complications were observed during the first year. Conclusion  Supplemental suture-button suspensionplasty can be utilized for high demand patients and patients who want to reduce immobilization time without major complications and with similar PRO as LRTI at 6 and 12 months. Level of evidence  Four case series.

Trapeziectomy and Suture-Button Suspensionplasty for Basilar Thumb Arthritis: Is It Enough to Prevent First Ray Subsidence?

Introduction  Trapeziectomy and suture-button suspensionplasty (SBS) are a novel option to treat end-stage trapeziometacarpal (TMC) osteoarthritis. Our purpose is to evaluate our outcomes with this technique and in this setting, with a minimum of 18 months of follow-up. Materials and Methods  Twenty-eight patients were included, operated between 2016 and 2018. We recorded demographic data, preoperative Eaton stage, follow-up and operative times. The patients completed the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire and tip pinch, key pinch, and grip strength were measured. First metacarpal subsidence was calculated, and postoperative complications were documented. Results  The average follow-up was 34 months. The mean QuickDASH was 32 at the final follow-up. The average strength results were 20 kg for grip, 3.6 kg for tip pinch, and 4.2 kg for key pinch. The rate of first ray subsidence was 10.7%. We encountered three complications: a hardware intolerance, a second metacarpal fracture, and a suture rupture. There was one reoperation to remove an implant. Conclusion  Trapeziectomy and SBS functional results are similar to other techniques, with less subsidence of the first ray and allowing for early mobilization and fast recovery. This procedure is a safe and promising option in the treatment of TMC osteoarthritis, with good medium-term outcomes.

Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition

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.

Suture Suspension Arthroplasty for Thumb Carpometacarpal Arthritis Reconstruction: 12- to 14-Year Follow-up

BACKGROUND

Many surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) joint osteoarthritis, with significant variation. To date, none has proven to be superior. The purpose of this study was to report long-term follow-up results of suture suspension arthroplasty (SSA).

METHODS

The SSA technique uses a single incision, trapeziectomy, and an intra-articular suture suspension sling anchored into the insertions of the flexor carpi radialis (FCR) and abductor pollicis longus (APL), which serves to stabilize the base of the thumb metacarpal, correct subluxation deformity, and maintain arthroplasty space. Ninety of 153 SSA reconstructions (59% recall) were evaluated at long-term follow-up (mean, 12.6 years). Data were analyzed for functional outcomes, including preoperative and postoperative grip and pinch strength, radiographs, complications, and postoperative Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) scores.

RESULTS

The mean age at date of surgery was 61.7 ± 7.6 years (82% women). Significant improvement was noted in grip strength (preoperative mean, 25.0 kg; postoperative mean, 28.0 kg; P < .0001), key pinch (preoperative, 4.2 kg; postoperative, 5.1 kg; P < .0001), and tip pinch (preoperative, 2.9 kg; postoperative, 3.6 kg; P < .0001). Radiographic subsidence averaged 35% (0-90). Postoperative QuickDASH scores (mean, 6.6; range, 0-50) revealed good to excellent pain relief and function. One revision was performed, and postoperative FCR rupture occurred in 3 reconstructions.

CONCLUSIONS

The SSA technique for thumb CMC arthritis reconstruction yields good to excellent long-term clinical outcomes. Potential advantages of the SSA include short operative time, a single incision, minimal cost, and no need for tendon harvesting, pin fixation, or implantable hardware.

Treatment of First Carpometacarpal Osteoarthritis with Arthroscopy: A Systematic Review

Background First carpometacarpal (CMC) osteoarthritis or trapeziometacarpal osteoarthritis is a common debilitating hand condition. No one surgical technique has demonstrated superiority in managing this disease. Purpose This study performed a systematic review of arthroscopic techniques for treating first CMC arthritis to assess the effectiveness of different arthroscopic techniques. Methods Grip strength, pinch strength, visual analog scale, the Disability of Arm, Shoulder, and Hand (DASH) score, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed, comparing outcomes of (1) trapeziectomy of any type versus debridement alone and (2) trapeziectomy alone versus interposition versus suspension techniques. Results Preoperative and postoperative scores significantly improved for DASH scores and pain at rest and with activity with variable improvements in ROM. Complications occurred in 13% of cases in publications that reported complications. When comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in interposition and suspension subgroups. Conclusions The existing literature describes a predominantly female population with Eaton-Littler stage II and III disease. In the subgroup analysis, arthroscopic techniques involving a trapeziectomy seem to be more effective at lowering pain scores compared to techniques involving debridement alone. Likewise, interposition and suspension techniques may show improved outcomes compared to techniques involving trapeziectomy alone. Level of evidence This is a Level III study.

Postoperative evaluation of modified abductor pollicis longus suspensionplasty using two anchors: Preliminary results

Among the various surgical treatments for basal joint arthritis, we modified abductor pollicis longus (APL) suspensionplasty by using two anchors. We hypothesized that this modification would prevent not only subsidence but also lateral migration of the first metacarpal. Thirteen thumbs that underwent APL suspensionplasty were investigated. Mean follow-up was 25 months (range, 12-69 months). Clinical and radiographic parameters were assessed preoperatively and postoperatively. Progression of subsidence (trapezial space) and lateral migration of the first metacarpal were investigated sequentially and with the thumb abducted or adducted against stress in a specifically designed mold. Clinical improvement was assessed by decrease in QuickDASH score (from 49.6 to 19.7). The immediate postoperative trapezial space decreased significantly by 39% (p = 0.003), and lateral migration was improved significantly by 14% (p = 0.007). At final follow-up, subsidence and lateral migration had not significantly progressed (p = 0.059 and 0.278, respectively). Under stress, the trapezial space ratio decreased significantly with the thumb in abduction (from 0.63 to 0.59, p = 0.011). APL suspensionplasty using two anchors in patients with basal joint arthritis maintained the position of the first metacarpal bone, and especially lateral subluxation. LEVEL OF EVIDENCE: IV.

"Suspensionplasty for Revision Thumb Carpometacarpal Osteoarthritis Surgery: Comparing Suture Button Suspensionplasty to Ligament Reconstruction and Tendon Interposition."

Several surgical procedures have been described for the treatment of thumb carpometacarpal (CMC) osteoarthritis (OA), including suture button suspensionplasty (SBS) and ligament reconstruction and tendon interposition (LRTI). To date, no one procedure has demonstrated clinical superiority. SBS has achieved favorable outcomes at five years in primary cases, but has not been validated in revision surgery. This study evaluated SBS for revision of failed thumb CMC OA surgery and compared these outcomes to revision using LRTI. A retrospective chart review was performed to identify patients who underwent suspensionplasty with SBS or LRTI after failure of previous thumb CMC OA surgery since 2010. Eighteen patients were included, nine undergoing revision with SBS and nine undergoing revision with LRTI. Eighteen patients had mean final follow-up of 35 months. There were two complications in the LRTI group, none in the SBS group. No patients required additional surgery. The SBS group had an average visual analog scale (VAS) pain score improvement of 2.9, compared to 2.4 in the LRTI group. Average final QuickDASH was 15.1 in the SBS group, compared to 22.6 in the LRTI group. Mean operative time of 86.3 minutes in the SBS group was significantly shorter than the 121 minute mean in the LRTI group. SBS is an effective treatment option for revision of previous thumb CMC OA surgery, with outcomes comparable to revision using LRTI, and the added benefit of shorter operative times and early mobilization.

Thumb basal joint arthritis: new classification, diagnostic and therapeutic algorithm

The assessment of thumb basal joint arthritis requires a radiographic evaluation and a classification of the lesions to guide the treatment choice. Arthritis of the thumb basal joint is not limited to trapeziometacarpal arthritis. The radiographic assessment must consider the scaphotrapeziotrapezoid joint, the entire carpus and the rest of the thumb column, in particular the metacarpophalangeal joint. There is currently no classification that captures all these items. This article reviews the existing classifications, proposes a new classification system that takes into account the entire thumb column and sets out the therapeutic options.

Revision Thumb Carpometacarpal Arthroplasty

Revision thumb carpometacarpal (CMC) arthroplasty alleviates persistent pain and instability after nonimplant or implant CMC arthroplasty. Metacarpal subsidence onto the scaphoid causing impingement, missed diagnosis such as scaphotrapezoid arthritis, and metacarpophalangeal hyperextension are common causes of failed CMC arthroplasty. Literature shows that revision CMC arthroplasty has satisfactory outcomes. Currently, the mantra of revision is to restore the metacarpal height and treat concomitant pathology, but no single operation is a universal solution. Revision CMC arthroplasty has a relatively high complication rate, lower patient satisfaction than primary CMC arthroplasty, and may result in the need for further operative intervention.

Arthroscopic Hemitrapezectomy and Suspension with Mini TightRope for the Treatment of Rhizarthrosis: Outcome in patients in stages Eaton-Littler 2 to 3

Introduction Rhizarthrosis is a common cause of pain and impaired function of the hand. Most patients present an excellent response to the conservative treatment, although a small percentage requires a surgical procedure due to the persistence of symptoms. Different surgical procedures have been described; however, there is still no consensus in the literature regarding the superiority of one technique over the others.

Objective To evaluate the clinical and radiological results of patients with a diagnosis of rhizarthrosis in stages 2 to 3 of the Eaton-Littler classification, submitted to arthroscopic hemitrapezectomy and suspension with Mini TightRope (Arthrex, Naples, FL, US).

Materials and methods We conducted a retrospective evaluation of the clinical and radiological results of patients operated on through the technique proposed in Clínica INDISA, in Santiago, Chile, between 2017 and 2019. The pre- and postsurgical assessments were performed using the visual analog scale (VAS) for pain, the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Kapandji score. The state of the articular cartilage was also evaluated intraoperatively according to the Badia classification.

Results A total of 12 patients (3 men and 9 women) met the inclusion criteria. Their mean age was 56 years, the mean duration of the follow-up was of 21 months. There were 7 patients in stage 2 and 5 in stage 3 according to the Eaton-Littler classification. Intraoperatively, there were 6 patients in stage II and 6 in stage III of the Badia classification. The mean preoperative score on the Kapandji index was of 3.6, and the mean postoperative score was of 9. The mean preoperative score on the VAS was of 8.8, and the mean postoperative score was of 1.2. The mean preoperative score on the DASH was of 33.3, and the mean postoperative score was of 4.7.

Conclusion Arthroscopic and suspension hemitrapezectomy with Mini TightRope for the treatment of stage 2-3 rhizarthrosis is a minimally-invasive, reproducible technique, effective in reducing pain and improving function, with sustained effects on the short and middle terms (6 to 36 months).

Arthroscopic Management of Thumb Carpometacarpal Joint Arthritis and Pathology

Basilar thumb arthritis is a debilitating condition characterized by pain, reduced joint stability, and reduced capacity for daily activities. Various arthroscopic approaches have been described based on patient factors, as well as radiographic and arthroscopic staging criteria. Here we provide an overview of arthroscopic management of basilar thumb arthritis, including patient evaluation, surgical techniques, outcomes, and new developments. We describe our preferred approach for Eaton stage I-III disease, consisting of arthroscopic hemitrapeziectomy with suture button suspensionplasty. This technique is safe, reliable, and allows for early range of motion and quicker recovery while minimizing scarring and reducing the risk of nerve injury.

Efficacy of Abductor Pollicis Longus Suspensionplasty Compared to Ligament Reconstruction and Tendon Interposition

Background: Multiple surgical techniques are described for basal joint osteoarthritis. This study compares clinical outcomes and patient satisfaction with trapeziectomy and abductor pollicis longus (APL) suspensionplasty compared to trapeziectomy with ligament reconstruction and tendon interposition (LRTI) when performed by 2 fellowship-trained hand surgeons. Methods: A retrospective review of 51 consecutive patients undergoing APL suspensionplasty (53 hands) was performed. With this technique, a distally based APL slip is brought through and sewn to the flexor carpi radialis (FCR). The remaining APL is placed in the trapeziectomy void. This technique was compared to 151 patients (166 hands) who underwent LRTI using the FCR tendon. Outcomes assessed included postoperative pain relief, grip and pinch strength, complications, and need for reoperation. Two-tailed, Fisher's exact test was used for data analysis. Results: APL suspensionplasty resulted in postoperative pain relief in 92.5% (n = 49) compared to 94.0% (n = 156) with LRTI (P = .758). Mean postoperative grip and pinch strengths with APL suspensionplasty were 41.2 and 10.4 kg, respectively. With LRTI, average grip strength was 42.0 kg, and pinch was 10.1 kg. Both techniques were well tolerated with minimal complications. In the APL group, 1 patient had a postoperative infection requiring drainage. Among the LRTI cases, 1 wound dehiscence required closure, and 2 minor postoperative wound infections resolved with oral antibiotics. Mean follow-up time among APL suspensionplasty patients was 3.3 months compared to 8.4 months following LRTI. Conclusions: APL suspensionplasty is a safe, effective procedure which provides similar pain relief and functional outcomes compared to LRTI.

Bone Tunnel Orientation in Suspension Arthroplasty of the Thumb Carpometacarpal Joint: An Anatomical Cadaver Study

Background: Ligament suspension after trapeziectomy is a common technique in patients with osteoarthrosis. In this study, we set out to determine whether the orientation of the bone tunnel in the first metacarpal base affects the intraoperative position of the first metacarpal after surgery. Methods: Trapeziectomy and Epping procedure were performed in 32 cadaver hands. A drill hole was placed in the base of the first metacarpal, leaving a radial to ulnar tunnel parallel to the joint surface or a diagonal bone tunnel from the radiodorsal surface to the ulnar joint surface of the first metacarpal. Positioning of the first metacarpal was studied via radiography. Results: The distance between the first metacarpal and the scaphoid after suspension arthroplasty was 9.5 ± 2.6 mm when using the parallel radioulnar bone tunnel and 10.9 ± 2.3 mm when using the diagonal bone tunnel. Suspension of the first metacarpal was 33% higher with the diagonal bone tunnel compared with when using the parallel bone tunnel (displacement of 2.8 ± 2.0 mm vs 4.2 ± 2.0 mm). Conclusions: Higher suspension of the first metacarpal after trapeziectomy can be significantly achieved in our cadaveric model when using ligament suspension of the flexor carpi radialis tendon passed from the ulnar joint surface to the dorsum of the metacarpal. Our results have to be determined via clinical examination. To date, we prefer the diagonal bone tunnel when performing ligament suspension arthroplasty.

Update on Thumb Basal Joint Arthritis Surgery

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.

Trapeziectomy with suture-button suspensionplasty versus ligament reconstruction and tendon interposition: a randomized controlled trial

The purpose of the present study was to compare the results of patients operated with trapeziectomy and ligament reconstruction and tendon interposition (LRTI) using flexor carpi radialis tendon versus trapeziectomy followed by suspension of the first metacarpal to the second metacarpal using a Mini TightRope® suture button (suture button suspension: SBS). A single-center prospective randomized controlled trial was performed, comparing 37 patients with SBS and 39 with LRTI. All surgeries were performed by the same fellowship-trained hand surgeon. Patients were assessed by an independent observer at 40 months' follow-up. Pre- and postoperative strength, trapezial space ratio (TSR), range of motion, QuickDASH and visual analogue pain score were recorded. Both procedures improved functional parameters of pain, key strength, tip strength and grip strength while maintaining range of motion, without significant differences. In the SBS group, TSR decreased by 17%, compared to 28% in the LRTI group. The mean operative time was shorter in SBS (63 vs 91 minutes; p < 0.0001), as was immobilization time (2 vs 6 weeks; p < 0.0001), and patients resumed normal activity sooner (10 vs 12 week; p = 0.0138) and required less physical therapy (19.3 vs 13.1 weeks; p < 0.0001). We believe that our results are related to the hypothesis suggested by biomechanical studies that revealed better initial load bearing profile and maintenance of trapezial space following serial loading in cadaver models.

Thumb carpometacarpal arthroplasty and trapeziectomy using a tenodesis screw compared to ligament reconstruction

This study aimed to compare the results of patients treated with a thumb carpometacarpal (CMC) suspension arthroplasty using an interference screw technique with patients that were treated by trapeziectomy and ligament reconstruction. A retrospective chart review was conducted of patients over 18 years old who required surgical treatment for thumb CMC joint arthritis treated by a single surgeon. Patients included in the study followed the same preoperative and postoperative protocol. Information related to functional outcomes was collected (pinch and grip strength, pain, Kapandji score, proximal migration of first metacarpal bone). One hundred and five patients were included, 77% were female, age at the time of the study was 62.7 years old; 74 (70%) patients were treated with the tenodesis screw (TS) technique and 31 (30%) with trapeziectomy and ligament reconstruction (TZLR). Patients were followed for a mean of 8.4 months. Postoperative pain was 1.2 in the TS group and 0.6 in the TZLR group; Kapandji score was 8.3 in the TS group and 9 in the TZLR group; in the TS group, the grip strength was 26.2kg and key pinch strength was 6.15kg; in the TZLR group, grip strength was 12.8kg and key pinch strength was 4.7kg. Proximal migration was 0.4cm in the TZLR group and 0.6cm in the TS group. The use of tenodesis screw and half of the flexor carpi radialis had minor advantages, such as increasing the grip and key pinch strength without differences relative the non-operated thumb, minimal migration of the first metacarpal bone compared with the other technique.

Technical trick in suture-button suspensionplasty for the treatment of thumb carpometacarpal arthritis

Suture-button suspensionplasty has been popularized in the treatment of thumb carpometacarpal (CMC) arthritis in recent years. The surgical technique of this method was well defined previously. The most challenging and important part of this technique is the tensioning of the suture-button system to preserve first metacarpal height after trapeziectomy. In present study, we would like to present a technical trick about adjusting the tension while performing suspensionplasty using suture-button device in thumb CMC joint osteoarthritis. In the original technique, trapeziectomy is performed prior to fixation and tensioning of suture-button system. However, it is quite difficult to recreate the original trapezial space, since first metacarpal subsides after trapeziectomy. The trick in our technique is that trapezium remains in its anatomic position up to the end of the operation. Thus, we do not need to make effort to adjust the thumb ray height and use fluoroscopic imaging to ensure its position. In conclusion, we believe that our technique simplifies the most challenging part of the operation, shortens the operation time, preserves the original first ray height and diminishes the exposure of ionizing radiation as it reduces the need for fluoroscopy.

Radiographic Outcomes in Treatment of Thumb Basal Joint Arthritis: Does Interposition of Acellular Dermal Allograft Prevent Metacarpal Settling?

Background  Osteoarthritis at the thumb carpometacarpal joint can have a profound impact on quality of life. Here, we evaluate radiographic outcomes in patients who have had open complete trapeziectomy, ligament reconstruction with tendon interposition, and acellular dermal matrix (GraftJacket) interposition-Group A, and compare them with those without GraftJacket interposition-Group B. Materials and Methods  Thirty patients who had undergone operative treatment for thumb basal joint arthritis by a single surgeon from 2009 to 2016 were identified, and charts were retrospectively reviewed for demographic data, surgical and radiographic outcomes, and complications. Results  There was no significant difference in pre- and postoperative radial abduction or pre- and postoperative palmar abduction. The difference in intraoperative joint space was significant ( p = 0.006), but the difference in postoperative joint space was not ( p = 0.310). The average amount of metacarpal settling was 6.9 versus 3.7 mm ( p = 0.035) (Groups A and B, respectively). Three patients in Group A developed an inflammatory reaction to the GraftJacket, and one required reoperation for allograft removal. Conclusion  This study suggests that thumb basal joint arthroplasty with GraftJacket interposition does not lead to more favorable radiographic outcomes at long-term follow-up. The increased costs associated with GraftJacket use may not be justified in light of these outcomes.

Thumb Carpometacarpal Suspension Arthroplasty With Flexor Carpi Radialis Ligament Reconstruction and Tendon Interposition Using An Absorbable Interference Screw: A Volar Approach Technique

The goal of operative intervention for pantrapezial arthritis is to relieve pain, maintain or improve motion, stability, and strength, and restore function. The purpose of this article is to present a volar approach to thumb carpometacarpal suspension arthroplasty using an absorbable interference screw for flexor carpi radialis ligament reconstruction and tendon interposition in the treatment of pantrapezial arthritis. This technique allows for visualization of the volar beak and avoidance of the radial artery and the branches of the superficial radial nerve while allowing optimal surgical manipulation for suspensionplasty with interference screw fixation and tendon interposition at the carpometacarpal joint.

Arthroscopic Trapeziectomy and Suture Button Suspensionplasty: A Review of the Literature and Description of the "Three-Step Arthroscopic Trapeziectomy Technique"

In the last two decades, surgeons have rapidly developed arthroscopic techniques to treat basal joint osteoarthritis. Such techniques spare the joint capsule and ligaments, allow more accurate staging of cartilage degeneration to determine the most appropriate treatment, and decrease the risk of injury to the radial artery and superficial branch of the radial nerve. Arthroscopic resection arthroplasty of the trapezium can be performed as either partial or complete trapeziectomy. Many papers have described partial trapeziectomy but few have discussed complete trapeziectomy. Suture button implants avoid the drawbacks of temporary fixation using Kirschner wire, as well as the drawbacks of ligament reconstruction, which necessitates the sacrifice of a tendon and involves both wide exposure and scar tissue. This paper aimed to review the published data on the arthroscopic treatment of basal thumb osteoarthritis, with a special focus on stabilization using suture button suspensionplasty, and to present a technique that structures this procedure into three steps, allowing it to be performed in an easier, more organized, and faster way.

Arthroscopic ligamentoplasty for osteoarthritis of the thumb carpometacarpal joints: Clinical and radiological outcomes with a minimum 2-year follow-up

BACKGROUND

We reported a new technique for arthroscopic ligamentoplasty for the thumb carpometacarpal osteoarthritis (CMC-OA) along with a minimum of 2 years of results.

METHODS

Twenty-nine thumbs with CMC-OA in stages II and III according to the Eaton and Glickel classification, were treated by arthroscopic ligamentoplasty. The procedure included partial trapeziectomy followed by ligamentoplasty similar to the Thompson technique. We evaluated pain VAS; DASH; grip and pinch strength; thumb abduction range of motion, and radiographic examination preoperatively and every 3 months until 1 year after surgery, and every 6 months thereafter. The mean duration of the follow-up was 3.2 years with a range of 2.0-6.0 years.

RESULTS

Pain, VAS, and DASH were significantly improved at 3 months after surgery than those preoperatively. Further, the strength of grip, tip, and key pinch significantly increased at 9, 9, and 12 months after surgery, respectively. Additionally, these improvements were maintained until the final follow-up. The range of motion tended to decrease in both palmar and radial abduction, although the differences were not significant. Radiographic examination after surgery showed that the ratio of trapezial space was significantly reduced because of surgical excision of the trapezium. However, there were no significant differences in the results between each follow-up time and the final follow-up. Moreover, the ratio of subluxation on the plain X-ray was significantly improved and maintained until the final follow-up. The parameters of clinical and radiographic outcomes, except motion, were significantly improved, even in patients with including those in stage III and with greater than 1/3 subluxation of the 1st metacarpal base on plain radiography.

CONCLUSION

Arthroscopic ligamentoplasty was effective for pain relief and improvement of grip and pinch strength for the patients with symptomatic CMC-OA.

LEVEL OF EVIDENCE

Therapeutic study/Level IV.

Suture Button Suspensionplasty in the Treatment of Carpometacarpal Arthritis: A Retrospective Analysis of One Surgeon’s Experience Over 9 Years

Purpose

Trapeziectomy with suture button suspensionplasty (SBS) to treat thumb carpometacarpal (CMC) arthritis has been proposed as an alternative to ligament reconstruction tendon interposition. There have been limited large-scale or long-term reports regarding SBS outcomes. Single-surgeon intermediate follow-up is reported.

Methods

We conducted a retrospective review of patients undergoing SBS procedures by a single surgeon. Implant manufacturer and postoperative immobilization protocol were recorded. Surgical outcomes, complications, and revision procedures were identified. Postoperative Disabilities of the Arm, Shoulder, and Hand scores were collected.

Results

A total of 242 SBS surgeries were included, involving 215 patients, average age 64.82 years (range, 42–86 years). Average follow-up was 35 ± 25 months. In all, 183 Arthrex and 59 Stryker systems were used, 42 of which were immobilized for 6 weeks after surgery and 200 of which were mobilized at 2 weeks afterward. Postoperative Disabilities of the Arm, Shoulder, and Hand surveys were completed by 122 patients (57%), with an average score of 12. No scaphometacarpal abutment was reported. Thirteen complications were reported (5%), 7 of which were implant-associated (3%) and 6 of which were not (2%). Implant-associated complications consisted of 3 suture button pull-outs, 2 thumb–index metacarpal abutments, one suture tail irritation, and one index metacarpal fracture. Operative revision was required in 4 of 7 implant-associated cases and 5 of 6 non–implant associated cases. No suture button pull-outs required revision surgery.

Conclusions

Results for a large series of SBS for CMC arthroplasty with intermediate follow-up revealed excellent clinical outcomes and low complication rates.

Clinical relevance

Suture button suspensionplasty as an alternative to ligament reconstruction tendon interposition may be a viable option for treating thumb CMC arthritis. In addition, a technique to manage thumb–index metacarpal abutment is described.

Unplanned Early Reoperation Rate Following Thumb Basal Joint Arthroplasty

Purpose

Thumb basal joint arthritis is a common degenerative condition of the hand that is often managed with thumb basal joint arthroplasty (BJA). This procedure generally results in a high level of patient satisfaction; however, the rate and cause of early unplanned reoperation after thumb BJA are not well-understood. Therefore, we performed a review to better understand the rate and cause of early reoperation.

Methods

A retrospective review of all thumb BJA cases performed at a single private academic center between 2014 and 2016 yielded 637 patients and 686 primary thumb BJAs with a minimum 1-year follow-up (mean, 2.4 years). Data collection included patient demographics, surgical technique and type of thumb BJA performed, time to reoperation, reason for early reoperation (within 2 years), and type of reoperation.

Results

Of 686 patients undergoing thumb BJAs, 10 had unplanned early reoperation (1.5%). Mean duration between the index procedure and reoperation was 5.2 months (range, 0.5–14.3 months). Of the 10 unplanned early reoperations, 4 thumbs in 4 patients required revision arthroplasties owing to persistent pain. Time to reoperation for revision arthroplasty was 9.6 months (range, 3.9–14.3 months). Three of 10 reoperations resulted from early infection, 2 from unplanned early removal of symptomatic K-wires, and one from radial sensory neuritis.

Conclusions

In this series of nearly 700 consecutive cases, we identified an unexpected early reoperation rate of 1.5%, with only a 0.6% reoperation rate specifically for painful subsidence requiring a revision arthroplasty. Mean time to revision was 9.6 months. These rates are lower than those published previously and should be considered by patients and surgeons when planning thumb BJA.

Type of study/level of evidence

Prognostic IV.

Suture Suspensionplasty Using Abductor Pollicis Longus and Flexor Carpi Radialis for Advanced Thumb Carpometacarpal Joint Arthritis

PURPOSE

Current operative treatment for advanced thumb carpometacarpal (CMC) joint arthritis mainly constitutes complete trapeziectomy with or without additional stabilizing procedures. However, it is unclear whether the additional procedures influence overall clinical outcomes. Therefore, the purpose of this study was to evaluate the effectiveness of our posttrapeziectomy suture suspensionplasty technique, performed using the abductor pollicis longus and flexor carpi radialis tendons, in patients with advanced thumb CMC arthritis.

MATERIALS AND METHODS

We evaluated 36 thumbs of 35 patients with advanced thumb CMC arthritis treated with combined operative excision of trapezium followed by a suture suspensionplasty using flexor carpi radialis and abductor pollicis longus tendons. We used a minimal volar approach to create a sling construct with a nonabsorbable suture material, which could support the thumb metacarpal base without pin fixation or tendon transfer. For radiographic evaluation, we used the ratio of the radial metacarpal subluxation to metacarpal articular width, estimated from the bilateral stress-view radiographic images of the thumb, and calculated the trapezial space ratio by dividing the trapezial space height by the proximal phalangeal length. The clinical outcomes were evaluated using the visual analog scale and disabilities of the arm, shoulder, and hand scores, along with evaluation of the improvement in both postoperative range of motion and strength recovery.

RESULTS

The mean duration of follow-up was 26 months (range, 18-60 months). The average visual analog scale and disabilities of the arm, shoulder, and hand scores decreased from 5.9 to 0.4 and from 51.6 to 27.0, respectively. The range of motion during palmar abduction and opposition of the metacarpophalangeal joint improved with an increase in mean value from 49.1 degrees to 54.1 degrees, and from 7.8 to 9.3 Kapandji score, respectively. The grip and key pinch strengths showed no significant changes from mean preoperative values of 13.3 kg and 3.8 kg to 13.2 kg and 3.2 kg, respectively, as measured at the 18-month follow-up.

CONCLUSIONS

Our suture suspensionplasty technique has several advantages including minimal invasive approach, short operative time, cost-effectiveness, and early mobilization. We suggest that it can be used as an effective, alternative stabilization method after a complete trapeziectomy.