APL Lasso Suspensionplasty for Trapeziectomy

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.

Biomechanical Analysis of Abductor Pollicis Longus Lasso Suspensionplasty for Trapeziectomy

PURPOSE

Multiple methods of ligament reconstruction and tendon interposition (LRTI) or suspension have been described to prevent first metacarpal subsidence following trapeziectomy. An abductor pollicis longus (APL) lasso is a newly described technique of suspensionplasty, which aims to obviate concerns regarding previously described methods. The purpose of this study was to compare subsidence between the APL lasso and 2 other common methods, APL sling and flexor carpi radialis LRTI, after trapeziectomy in cadaveric forearms.

METHODS

Ten cadaveric forearms were prepared on a custom-made plinth to recreate pinch grip upon the loading of previously identified muscles. A sequence of procedures was performed, with radiographs taken after each to assess the subsidence.

RESULTS

The APL lasso was superior to simple trapeziectomy and flexor carpi radialis LRTI in preventing subsidence.

CONCLUSIONS

The APL lasso was superior to simple trapeziectomy and flexor carpi radialis LRTI in preventing subsidence, and it may be a viable alternative when considering suspension methods after trapeziectomy.

CLINICAL RELEVANCE

The APL lasso may be considered when trying to prevent subsidence after trapeziectomy.