Anatomical and Biomechanical Studies of the Pathogenesis of Trapeziometacarpal Degenerative Arthritis

Abstract

An anatomical and biomechanical study of the stabilizing ligaments of the thumb trapeziometacarpal joint was conducted on 32 hand specimens. Five main ligamentous structures could be identified. The mechanical properties (in particular, strength) of the five ligaments using a strain-rate failure test were determined and evaluated quantitatively. The maximum tensile strength of each ligament was correlated with the condition of the trapeziometacarpal articular cartilage. In studying the anterior oblique ligament, maximum strength decreased from Grade 0 to Grade 1 by 51%. With the first intermetacarpal ligament, the drop from Grade 1 to Grade 2 was 53%. With the posterior oblique ligament, the decrease was closely related to the grade of the deterioration of the trapeziometacarpal articular surface. These three ligaments also significantly decreased in strength with age. Our results may suggest that the anterior oblique ligament, intermetacarpal ligament and posterior oblique ligament play a large role in stabilizing the trapeziometacarpal joint and that the decrease in their strength is related to the pathogenesis of trapeziometacarpal osteoarthritis.

Comparative in vivo kinematic analysis of normal and osteoarthritic trapeziometacarpal joints

“…Najima et al 10 showed that the ligament strengths of the anterior oblique ligament, the intermetacarpal ligament, and the posterior oblique ligament decreased with age and suggested that the decrease in strength was related to the pathogenesis of the TM joint. The present results, however, show that aging alone does not significantly affect the kinematics of the TM joint.…”

Microstructural adaptation in trapezial bone due to subluxation of the thumb

“…1 Although etiology and pathogenesis of the disease are not totally understood, there is anatomical and biomechanical evidence that the ligamentous structures surrounding the trapeziometacarpal joint become weaker with age, leading to instability of the thumb saddle joint and thus supporting the progress of a CMC I osteoarthritis. [2][3][4][5][6][7] There is a large variety of surgical procedures to treat the disease. Early stages I and II according to Dell 8 can be treated with ligament reconstruction according to Eaton 9 or Brunelli, 10 by abductortomy according to Zancolli,11 or with osteotomy according to Wilson.…”

Interobserver Agreement of the Eaton-Littler Classification System and Treatment Strategy of Thumb Carpometacarpal Joint Osteoarthritis

“…1 It causes pain and disability in daily activities and can be responsible for inability to work, especially in manual laborers. 2 Diagnosis is mainly based on history, clinical examination, and plain x-rays. There are 2 major classification systems for CMC1 osteoarthritis.…”