Arthroscopic Hemitrapeziectomy and Suture Button Suspensionplasty in the Treatment of First Carpometacarpal Joint Eaton–Littler Stage 2–3 Arthrosis

Abstract

Background Degenerative arthritis of the first carpometacarpal (CMC) joint is a common degenerative condition in the hand. Many different surgical procedures have been applied for years. However, in the studies there is no consensus about the superiority of one technique to another. Questions/Purposes In this study, we evaluated the results of the patients with first CMC Eaton–Littler stage 2–3 arthrosis who were operated to prevent first metacarpal joint lateral subluxation and migration with arthroscopic hemitrapeziectomy and suture button suspensionplasty. Patients and Methods Between 2011 and 2014, 21 patients (16 female, five male) were evaluated retrospectively. Mean age was 52.3 years. The preoperative and postoperative assessments were performed with visual analog scale (VAS) and disabilities of the arm, shoulder, and hand score (DASH) scores. The Kapandji's thumb opposition score was used to assess thumb range of movement. The patients were assessed after arthroscopy according to Badia classification. Results Mean follow-up period was 50.1 months. According to Badia classification, seven patients were found to be type 2 and 14 patients were type 3. The mean preoperative Kapandji's score was 7.6 and the mean postoperative Kapandji's score was 9.2. The mean VAS values were 8.2 preoperatively and 1.9 postoperatively. The mean preoperative DASH value was 23.4 and the mean postoperative DASH value was 5.5. The mean preoperative grip strength was 66.2 and the mean postoperative grip strength was 75.1. The mean preoperative pinch strength was 14.8 and the mean postoperative pinch strength was 20.2. Conclusion Arthroscopic hemitrapeziectomy and suture button suspensionplasty is a minimal invasive technique and can be performed with low morbidity in the treatment of first CMC joint Eaton–Littler stage 2–3 arthrosis. By this technique, the patients' existing instability and pain problems can be solved. Complications, such as loosening of the suture button at the first metacarpal at the postoperative period due to direct trauma to the first CMC joint, could be avoided using a new suture button. Type of Study/ Level of Evidence Therapeutic IV.

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

“…At the time of this review, the latest study on hemitrapeziectomy and SBS was that published by Özçelik et al 14 in 2019. They reported the results of the procedure in 21 patients.…”

“…Eaton classification, 4 whereas the latter can also be performed in stage IV cases. Many papers have described partial trapeziectomy, [5][6][7][8][9][10][11][12][13][14][15][16] but few have discussed complete trapeziectomy. 17,18 Numerous open surgery techniques, such as temporary Kirschner wire fixation, 19 soft tissue interpositions, 20 ligament reconstruction with or without tendon interposition, 21 and, more recently, suture button suspensionplasty (SBS), 22 have been developed to prevent proximal migration of the first metacarpal bone once the trapezium is removed.…”

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

“…The decision to use the suture-button system for thumb metacarpal suspension was based on the fact that it is easy to use and could decrease operating time, and, theoretically, it would not carry some of the risks associated with ligament reconstruction and tendon interposition, including subsidence of the thumb metacarpal 4 , 5 . In time, this technique has been accepted by other surgeons and performed frequently in the treatment of first CMC joint osteoarthritis 6 , 7 , 8 , 9 . The surgical technique of this method was well defined previously 5 .…”

Arthroscopic Complete Trapeziectomy and Suspension Arthroplasty: “Three-Steps Arthroscopic Trapeziectomy Technique”

“…The former is indicated in stage II or III cases, according to the Eaton classification [2], while the latter can also be performed in stage IV cases. Many papers have described partial trapeziectomy [3][4][5][6], but few have discussed complete trapeziectomy [7,8].…”