Assessment of Dorsal Subluxation in Thumb Carpometacarpal Osteoarthritis

Preservation Arthroplasty for Basal Joint Arthritis Using Arthroscopy and Autologous Fat Grafting With Platelet-rich Plasma

Background

Prior studies have shown that intra-articular injection of autologous fat may be a viable, less invasive approach for the treatment of carpometacarpal (CMC) joint arthritis, compared with trapeziecetomy. Small joint arthroscopy has also been found to be a useful tool in evaluation and treatment of arthritis. The authors present a treatment for CMC arthritis combining a minimally invasive approach for arthroscopic debridement with autologous fat grafting and platelet-rich plasma (PRP) injection.

Methods

Patients with Eaton stage II-IV CMC osteoarthritis underwent arthroscopic debridement and injection of autologous fat and PRP into the joint. Pre- and postoperative pain scores, functional outcomes, radiographic improvement in joint subluxation, patient satisfaction, and complications were evaluated.

Results

Forty-eight thumb CMC joint arthroscopies with fat grafting and PRP were performed. No intraoperative or immediate postoperative complications were experienced. No patients required revision surgery. Average preoperative pain scores with activity improved from 8.9 ± 0.9 to 3.3 ± 2.2 (P < 0.0001) and at rest improved from 5.0 ± 2.5 to 1.0 ± 1.3 (P < 0.0001). M1M2 overlap was used to measure radiographic subsidence. This improved from 4.4 ± 2.8 mm preoperatively to 6.8 ± 2.3 mm postoperatively, reflecting a relative improvement of 70% (P < 0.0042). High patient satisfaction was noted.

CONCLUSIONS

Treatment of the CMC joint using arthroscopic technique combined with autologous fat and PRP is effective in treating pain and joint subluxation. Additional prospective studies are underway for comparison to traditional arthroplasty techniques and to evaluate this technique's potential for other small joint pathology.

Radiological imaging of the trapeziometacarpal joint: a historical and clinical perspective

The opposable thumb provides both stability and mobility and is needed to accomplish different prehensile tasks. The trapezium is a complex bone, with a distal articular surface that is convex in the sagittal plane of the thumb and concave in the coronal plane of the thumb. The numerous additional articulations with the carpus and the oblique orientation to the main plane of the hand makes it difficult to evaluate the trapeziometacarpal joint using standard hand or wrist radiographic views. This review gives an overview of the different radiological views that have been described for the thumb with an emphasis on their historical origin and positioning during radiography. We also describe different measurements and classifications that can be obtained using different thumb radiographs.

Management of Thumb Metacarpophalangeal Hyperextension in the Setting of Thumb Basal Joint Arthritis

Thumb metacarpophalangeal (MCP) joint hyperextension is a well-established sequela of advanced carpometacarpal (CMC) joint arthritis. This deformity results in poor patient function because the ability to perform key pinch is negatively affected. For this reason, surgeons must consider the presence of an MCP deformity when addressing CMC arthritis. A variety of nonsurgical and surgical interventions have emerged. Surgical treatments can be grouped into four main categories: (1) volar plate advancement/capsulodesis, (2) tendon transfer and tenodesis, (3) sesamoidesis, and (4) arthrodesis. Surgical intervention is based on both the degree of deformity present and the surgeon preference. This review aims to clarify indications for various treatments of MCP joint hyperextension, outline commonly performed procedures, and report the published outcomes and potential complications of these interventions.