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Trapeziectomy with Abductor Pollicis Longus Tendon Interposition Arthroplasty for First Carpometacarpal Joint Osteoarthritis: A Systematic Review. World J Plast Surg 2022; 11:3-17. [PMID: 36117891 PMCID: PMC9446120 DOI: 10.52547/wjps.11.2.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 03/23/2022] [Indexed: 11/18/2022] Open
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Merendi G, Fulchignoni C, Pietramala S, Rocchi L. Trapeziectomy and suspension ligamentoplasty for surgical revision of trapeziometacarpal joint arthrodesis failure: two cases. HAND SURGERY & REHABILITATION 2022; 41:400-403. [PMID: 35476953 DOI: 10.1016/j.hansur.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/20/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022]
Abstract
Trapeziometacarpal joint osteoarthritis is a common degenerative disease. Arthrodesis is a widespread historical surgical technique to treat this pathology, providing pain relief and stability and strength of the thumb. Nevertheless, pantrapezial arthritis and non-union are not uncommon complications, leading in some cases to revision surgery. No gold-standard procedure has been described for revision of trapeziometacarpal arthrodesis failure. We describe two cases of failed arthrodesis treated with trapeziectomy and suspension ligamentoplasty, a well-known, biological, low-cost, successful, and easy-to-perform procedure.
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Affiliation(s)
- G Merendi
- Hand Surgery and Orthopedics Unit, Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy
| | - C Fulchignoni
- Hand Surgery and Orthopedics Unit, Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy.
| | - S Pietramala
- Hand Surgery and Orthopedics Unit, Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - L Rocchi
- Hand Surgery and Orthopedics Unit, Department of Orthopedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli 8, 00168 Rome, Italy; Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
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Sander AL, Buhrmann CF, Sommer K, Frank J. Simplified abductor pollicis longus suspension interposition arthroplasty for thumb carpometacarpal joint osteoarthritis. Eur J Trauma Emerg Surg 2022; 48:1225-1230. [PMID: 33367972 PMCID: PMC9001229 DOI: 10.1007/s00068-020-01577-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE The primary treatment goals for advanced-stage thumb carpometacarpal (CMC) joint osteoarthritis are complete pain relief and restoration of thumb strength. The purpose of the present study was to introduce a variation of the abductor pollicis longus (APL) suspension arthroplasty using a single looping of a radial slip from the APL tendon around the flexor carpi radialis (FCR) tendon combined with RegJoint™ interposition and to determine its efficacy in the treatment of thumb CMC joint osteoarthritis. METHODS Between 2015 and 2017, 21 patients were included. The average age was 60.8 years (range 48-79). The mean follow-up was 27.7 months (range 8-50). Evaluation included pain, radial and palmar abduction, tip pinch and grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) score. RESULTS Pain averaged 0.3 (range 0-4) at rest and 1.4 (range 0-4) on exertion. The radial and palmar abduction were 97% and 99% compared to the contralateral side. The tip pinch and grip strength were 4.1 kg (range 3-6.5) and 22 kg (range 13.3-40), respectively. The DASH score accounted for 18.5 (range 0.8-41.7). CONCLUSION The modified APL suspension interposition arthroplasty was an efficient and simplified option for the treatment of thumb CMC joint osteoarthritis, with results comparable or better than other published procedures. The APL suspension technique was easy to perform avoiding difficult bone tunneling and incision of the FCR tendon. The RegJoint™ interposition as spacer prevented impingement of the first metacarpal base on the second metacarpal base or the trapezoid bone.
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Affiliation(s)
- Anna Lena Sander
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - Clara Friederike Buhrmann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Katharina Sommer
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Johannes Frank
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Trapeziectomy and suspension arthroplasty with the flexor carpi radialis tendon for treatment of trapeziometacarpal osteoarthritis. HAND SURGERY & REHABILITATION 2021; 40:162-166. [PMID: 33508523 DOI: 10.1016/j.hansur.2020.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 11/23/2022]
Abstract
Excision of the trapezium is the common step in most arthroplasties for treating trapeziometacarpal arthritis. Trapeziectomy can be supplemented by several techniques intended to stabilize the first metacarpal but none of these has been proven superior. The aim of this study was to verify if a simplified suspension arthroplasty with the flexor carpi radialis (FCR) tendon, requiring only a single short surgical incision, no intraosseous tunnels and no interposition of prosthetic material, yields equal clinical outcomes to more complex techniques and if the clinical outcomes remain stable over the long term. A cohort of 299 patients was reviewed retrospectively at a follow-up ranging from 3 to 12 years (mean follow-up time 6 years) following total trapeziectomy and suspension arthroplasty using a half-tendon strip of FCR. At this long-term follow-up, the mean DASH score improved from 52 preoperatively to 20 postoperatively. Pain at follow-up was subjectively rated by patients as absent or improved in 92% cases. Thumb opposition assessed on the Kapandji scale was rated 9 or 10 in 144 (76%) hands, 7 or 8 in 30 (16%) hands and <7 in 15 hands (8%). Mean palmar flexion and radial abduction were 45° and 42°, respectively. Mean key pinch and grip strength were 4.7 Kg and 23.5 kg, respectively. When treating trapeziometacarpal osteoarthritis, surgical techniques that do not require complex procedures, bone tunnels, K wire stabilization or interposition of prosthetic materials can be considered and maybe preferred. Our technique of trapeziectomy and suspension arthroplasty with the FCR tendon produces good long-term results.
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F. Brunelli Ligamentoplasty as Treatment in Thumb Basal Joint Arthritis: Up to 9 Years Follow-up. Tech Hand Up Extrem Surg 2020; 25:77-83. [PMID: 32740056 DOI: 10.1097/bth.0000000000000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Thumb basal joint arthritis treatment with biological arthroplasty is a widely used procedure in hand surgery centers. The several described techniques are based on the use of different tendons of the wrist, implying frequently a tenoplasty around flexor carpi radialis or transosseous tunnels to stabilize the articulation. The authors have been using, for many years, the technique conceived by F. Brunelli that relies on the anchorage of the volar band of the abductor pollicis longus tendon to the first intermetacarpal ligament, to obtain a suspension arthroplasty. Technical details are discussed. Sixty-seven patients in Eaton-Littler stage 2 or 3 with >4 years follow-up after surgery were evaluated. Each patient expressed a subjective evaluation relating to pain, functionality, strength, esthetic aspect, and general satisfaction. The following parameters have been considered as objective data: the angle of the first web space, the abduction and opposition of the first digit, the pinch, and the strength. X-rays were also performed to verify the distance between the scaphoid and the first metacarpal. In 84% of cases, a significant improvement was found in the considered parameters. Joint space was maintained in 76% of cases at radiologic follow-up. No patient needed surgical revision. The tenoplasty conceived by F. Brunelli presents several advantages, including the simple and reproducible execution, short surgical time, and comfortable postoperative course for the patient. After mid-term follow-up, authors believe this procedure is particularly respectful of the anatomy and physiology of the first ray and gives optimal results in most of the cases, but, in patients with severe subluxation of the 1st metacarpal (identifiable as Eaton-Littler stage 3), it is less reliable, because of the degeneration of the intermetacarpal ligament.
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Rezzadeh K, Donnelly M, Daar D, Hacquebord J. Scaphometacarpal Space and Postoperative Outcomes: A Systematic Review. J Wrist Surg 2020; 9:263-267. [PMID: 32509434 PMCID: PMC7263858 DOI: 10.1055/s-0039-1692477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Accepted: 05/03/2019] [Indexed: 10/26/2022]
Abstract
Background A common notion is that more complex techniques for treating trapeziometacarpal arthritis such as ligament reconstruction and tendon interposition (LRTI) better preserve the scaphometacarpal (SMC) space compared to a simple trapeziectomy and that this leads to superior functional outcomes. Purpose The purpose of this systematic review is to evaluate the relationship between scaphometacarpal space and objective outcomes such as grip and pinch strength as well as subjective patient-reported outcomes. Methods A systematic review of the literature was conducted according to PRISMA guidelines. Inclusion criteria were studies reporting SMC space and outcomes after surgery for carpometacarpal arthritis. The primary outcomes of these studies included any measure of postoperative scaphometacarpal space (trapezial height/trapezial index) as well as key pinch strength, grip strength, or lateral pinch strength. Studies that did not assess for association between SMC space and outcomes were excluded. Results Fourteen studies were included in this systematic review. Three (21.4%) studies found a statistically significant correlation between postoperative SMC space and postoperative pinch or grip strength. The correlation was weakly positive in one study (key pinch vs. scaphometacarpal space, r = 0.13), positive but unlisted in another (lateral pinch vs. trapezial ratio), and negative in the third study (key pinch vs. trapezial space ratio, r = -0.47). Conclusion Preservation of the SMC space postoperatively is not associated with postoperative outcomes. Further research is necessary to better characterize the importance of maintaining the SMC space in patients undergoing LRTI in order to substantiate claims by proponents of the procedure.
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Affiliation(s)
- Kevin Rezzadeh
- Department of Orthopaedic Surgery, School of Medicine, New York University, New York
| | - Megan Donnelly
- Department of Orthopaedic Surgery, School of Medicine, New York University, New York
| | - David Daar
- Hansjörg Wyss Department of Plastic Surgery, School of Medicine, New York University, New York
| | - Jacques Hacquebord
- Department of Orthopaedic Surgery, School of Medicine, New York University, New York
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Wilkens SC, Meghpara MM, Ring D, Coert JH, Jupiter JB, Chen NC. Trapeziometacarpal Arthrosis. JBJS Rev 2020; 7:e8. [PMID: 30672779 DOI: 10.2106/jbjs.rvw.18.00020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Suzanne C Wilkens
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael M Meghpara
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - J Henk Coert
- Department of Plastic Surgery and Hand Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jesse B Jupiter
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal C Chen
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Wouters RM, Tsehaie J, Hovius SE, Dilek B, Selles RW. Postoperative Rehabilitation Following Thumb Base Surgery: A Systematic Review of the Literature. Arch Phys Med Rehabil 2018; 99:1177-1212.e2. [DOI: 10.1016/j.apmr.2017.09.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
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Rocchi L, Merolli A, Giordani L, Albensi C, Foti C. Trapeziometacarpal joint osteoarthritis: a prospective trial on two widespread conservative therapies. Muscles Ligaments Tendons J 2018; 7:603-610. [PMID: 29721463 DOI: 10.11138/mltj/2017.7.4.603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The trapeziometacarpal (TMC) joint osteoarthritis (OA) is at the origin of important secondary functional disability to pinch as well as a painful grip. Several conservative therapies are often considered in the early stages of TMC OA to decrease pain, recover function and slow the evolution of OA. They include massage therapy, heat applications, stretching of the first web span and assisted mobilization of the TMC joint. However, as with other arthritic joints, many physicians often suggest administering intra-articular corticosteroids. The aim of this study was to assess the effect of 10 sessions of physiotherapy versus a single corticoid intra-articular injection. Both treatments were associated with TMC splinting. Methods Two groups of twenty-five patients received either physiotherapy or a corticoid injection. They were followed over a one-year period. All of them were assessed for pain, function, strength at 2, 6 and 12 months and overall satisfaction at the end of the study. Results With the infiltrative therapy, the parameters improve more quickly, whereas patients treated with physiotherapy show longer persistence regarding remission of pain. The final functional evaluation scores at one year are similar to pretreatment scores. Conclusion In early stages of TMC OA, corticosteroids articular injections and physiotherapy treatments can improve the painful symptoms but treatment with corticosteroids is faster. Although hand functions return to average scores similar to those of pre-treatment, physiotherapy program is associated with a longer remission of pain.
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Affiliation(s)
- Lorenzo Rocchi
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics & Traumatology Sciences, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Merolli
- Orthopaedics & Hand Surgery Unit, Department of Orthopaedics & Traumatology Sciences, Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Laura Giordani
- Physical Medicine and Rehabilitation, Tor Vergata University, Rome, Italy
| | - Caterina Albensi
- Physical Medicine and Rehabilitation, Tor Vergata University, Rome, Italy
| | - Calogero Foti
- Physical Medicine and Rehabilitation, Tor Vergata University, Rome, Italy
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Slip abductor pollicis longus suspension tendinoplasty for management of trapezio-metacarpal joint osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2015. [PMID: 26224614 DOI: 10.1007/s00264-015-2904-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Trapezio-metacarpal (TM) joint arthritis is a common cause of pain and functional disability of the hand. The ideal surgical procedure for TM joint osteoarthritis is still controversial. The aim of the current study is to assess the outcome of complete trapezial excision and abductor pollicis longus tendon interposition arthroplasty in the treatment of TM osteoarthritis. METHODS Twenty patients (16 women and 4 men) were prospectively enrolled in the current study with average age of 51.5 years (36-64). All patients had complete trapezial excision and abductor pollicis longus tendon interposition arthroplasty with minimum follow-up of 24 months. RESULTS At final follow-up there was significant improvement as regard pain, range of motion, and functional assessment scores. Pre-operative visual analogue scale (VAS) for pain improved from 6.2 (±1.54) to 1.1 (±0.97), and the average Quick DASH Score improved from 47.6 (±8.81) points pre-operatively to 13.6 (±5.46) points post-operatively. The mean pre-operative Buck-Gramcko score system improved from 21 (±6.2) points to 41.5 (±7). The average post-operative satisfaction score was 9.1(±2.1), with all the patients somewhat satisfied and recommending operation to other patients. CONCLUSIONS The total trapeziectomy tendinoplasty with suspension and interposition using the abductor pollicis longus is a reliable procedure for the treatment of TMJ osteoarthritis, providing satisfactory functional results.
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Berger AJ, Meals RA. Management of osteoarthrosis of the thumb joints. J Hand Surg Am 2015; 40:843-50. [PMID: 25754790 DOI: 10.1016/j.jhsa.2014.11.026] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
We present current concepts and evidence to optimize diagnosis and management of osteoarthritis in the thumb joints. Numerous options and controversies exist for surgical treatment of carpometacarpal joint arthritis. Fewer options exist for metacarpophalangeal joint arthritis. Surgical treatment for interphalangeal arthritis is mainly arthrodesis.
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Affiliation(s)
- Aaron J Berger
- Division of Plastic Surgery, Florida International University College of Medicine & Miami Children's Hospital, Miami, FL
| | - Roy A Meals
- Department of Orthopedic Surgery, University of California at Los Angeles, Los Angeles, CA.
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