Contact patterns in the trapeziometacarpal joint: The role of the palmar beak ligament

Pellegrini, Vincent D.; Olcott, Christopher W.; Hollenberg, Gary

doi:10.1016/0363-5023(93)90354-6

Cited by 175 publications

(113 citation statements)

References 9 publications

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“…One difficulty in evaluating the impact of laxity on arthritic development is that the joints measured by the Beighton-Horan score have overall decreased mobility with age, and there is no alternative to measure joint mobility in older persons. Pellegrini et al and others postulated that the development of thumb CMC arthritis was the result of attenuation and laxity of the supporting ligaments of the joint [10,34]. We have previously shown that radiographic laxity at the thumb CMC joint is correlated with generalized joint laxity with a significantly higher degree of both generalized laxity and radiographic laxity in women [47].…”

Section: Discussionmentioning

confidence: 69%

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Wolf

Scher

Etchill

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background The female predominance in thumb carpometacarpal (CMC) joint arthritis has led to speculation that reproductive hormones or hypermobility are responsible. Evidence shows that patients with pathologic laxity have a higher rate of thumb CMC arthritis. Relaxin hormone increases laxity in the pelvic ligaments through upregulation of matrix metalloproteases (MMPs). It is thus a hormone of interest in the development of thumb CMC arthritis. Questions/purposes Our goals were to identify demographic and hormonal factors associated with joint laxity in patients with CMC arthritis and to evaluate the relationship among serum relaxin, relaxin receptors, and MMPs in the anterior oblique ligament (AOL) of the thumb. We hypothesized that serum relaxin was correlated with joint laxity as well as with relaxin receptors and MMPs in the AOL. MethodsForty-nine patients undergoing thumb CMC arthroplasty underwent laxity examination, blood draw, and AOL sampling. Ligaments were analyzed for relaxin receptor and MMPs 1 and 3 using quantitative reversetranscriptase polymerase chain reaction. Results Women demonstrated more joint laxity than men (p \ 0.001). RNA analysis confirmed relaxin receptors in the AOL as well as MMPs 1 and 3. There was a significant correlation between serum relaxin and MMP-1 (p = 0.04). Detectable serum relaxin was negatively correlated with relaxin receptors in the AOL (p = 0.02). Conclusions Further studies are needed to evaluate the role of laxity and sex hormones in thumb CMC arthritis.

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Section: Discussionmentioning

confidence: 69%

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Wolf

Scher

Etchill

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…This suggests a concept of physiological peak forces through the middle and ulnar columns in healthy CMC I joints and underlines the importance of the palmar beak ligament that holds the joint centered and distributes the forces across a greater surface. 39,40 The three compartments of the osteoarthritic trapezia-radial, middle, and ulnar-revealed an individual bone reaction to the osteoarthritic disease. Higher bone volume fraction (BV/TV) in osteoarthritis as a measure for apparent bone mineral density was most pronounced in the radial compartment (Fig.…”

Section: Discussionmentioning

confidence: 99%

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Nufer

Goldhahn

Köhler

et al. 2007

Journal Orthopaedic Research

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Although the thumb saddle is one of the most common sites of degenerative osteoarthritis in the hand, little is known about the altered microstructure in osteoarthritic trapezial bones. External forces resulting from subluxation of the carpometacarpal joint of the thumb (CMC I) should provoke microstructural changes in the trapezium. The purpose of this study was to compare the regional differences of the microstructure between osteoarthritic and healthy trapezial bones. Fifteen trapezia harvested from female patients with radiologically and clinically diagnosed saddle joint osteoarthritis (OA) were compared with 15 unaffected controls. Microstructural parameters, such as bone volume ratio (BV/TV), three-dimensional connectivity (Conn.D), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were studied using a microcomputed tomography (microCT) system. While the trapezial height in OA was 22% less, the sclerotic subchondral bone layer thickness was 50% higher in OA compared with the control group (p < 0.001). In the OA group there was a 42% higher bone volume ratio (p 0.001), an 18% increase in Tb.Th (p ¼ 0.006), and a 10% greater Tb.N (p ¼ 0.034) compared with the control group. Although in both groups BV/TV was significantly lower in the radial region, the radial column showed the highest relative increase in bone volume and structure compared with the control group (þ67% BV/TV, þ20% Tb.Th, þ23% Tb.N). The reinforcement of the bony microstructure in CMC I OA, especially at the radial side, is a sign for bone adaptation reacting to radially shifted joint forces. This has to be considered during the development of new prosthetic alternatives. ß

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“…3 The SBS group underwent a trapeziectomy and SBS using the Mini TightRope (Arthrex) as described by Cox et al 6 Each specimen was then mounted using a clamp holding the proximal radius and ulna. We used previously described and validated testing protocols to simulate key pinch of approximately 32 N. 4,17,22,23 Load was applied using fishing line and weights attached to the sutures in each muscle-tendon unit (EPL: 2.5 lbs; EPB: 2.5 lbs; AP: 2.5 lbs; FPL: 5 lbs; total: 12.5 lbs) as described by Putnam et al to generate pinch ( Figure 2). 23 After simulation of key pinch, the first metacarpal was axially loaded in an incremental fashion utilizing a 2.0-mm Steinman pin placed through its middle third from dorsal to volar.…”

Section: Methodsmentioning

confidence: 99%

Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis

Desai

Brogan

Richard

et al. 2016

Hand (New York, N,Y.)

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Surgery ArticleOsteoarthritis (OA) at the base of the thumb can cause severe pain, weakness, and deformity and can result in marked disability. 14 The unique anatomy of the thumb carpometacarpal (CMC) joint predisposes it to degenerative arthritis. 5,27 Specifically, the degree of weakening of the palmar beak ligament has been correlated with degenerative processes in the joint and is the target of ligament reconstruction for symptomatic arthritis. 7 Degenerative OA at the thumb CMC joint is treated initially with activity modification, splinting, medication, and intra-articular corticosteroid injections. 34 For advanced disease, or when nonoperative treatments have failed, surgical intervention can be considered. Surgical options include volar ligament reconstruction, 11 first metacarpal osteotomy, 13 CMC joint arthrodesis, 12 total joint arthroplasty, 1 and trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI). 3,9 Comparative studies have shown no significant long-term difference in outcomes among these techniques, 18,[29][30][31] aside from a lower complication rate 30,31 and shorter operative time with trapeziectomy alone. 20 The use of a suture-button suspensionplasty (SBS) with trapeziectomy has grown in popularity. 6,24,35,36 Advocates of this technique cite safety, ease of use, early mobilization, and good early results. 35,36 However, it is not known how effectively the SBS withstands metacarpal subsidence under loaded conditions. The purpose of this study was to biomechanically compare the more widely adopted LRTI procedure with SBS using a cadaveric model. We hypothesize that the SBS will result in a biomechanically stronger construct with immediate loading. Demonstration of an enhanced ability to withstand early active pinch while preventing metacarpal subsidence may support early motion rehabilitation protocols. Abstract Background: The purpose of this study was to compare the initial biomechanical strength of trapeziectomy and suturebutton suspensionplasty (SBS) with ligament reconstruction and tendon interposition (LRTI) for thumb carpometacarpal (CMC) arthritis in a cadaveric model. Methods: Eight matched pairs of below-elbow cadaveric arms were used for this study. Each specimen was randomly assigned to either receive a trapeziectomy and LRTI (LRTI group) or trapeziectomy and SBS (SBS group). Using previously described and validated testing protocols, physiological key pinch was simulated. The thumb metacarpal was then incrementally loaded from 5 to 20 lbs, using 5-lb increments. Metacarpal subsidence during physiological key pinch and incremental loading was determined using radiographic measurements of trapezial space height. Results: The average pretesting trapezial space height did not differ significantly between the LRTI (11.9 mm) and SBS (13.7 mm) groups. After simulated physiological key pinch, the SBS group had significantly greater average trapezial space height compared with the LRTI group (8.0 mm vs 5.5 mm). For each incremental metacarpal load from 5...

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Contact patterns in the trapeziometacarpal joint: The role of the palmar beak ligament

Cited by 175 publications

References 9 publications

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis

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