Early Treatment of Degenerative Arthritis of the Thumb Carpometacarpal Joint

Yao, Jeffrey; Park, Min J.

doi:10.1016/j.hcl.2008.03.001

Cited by 70 publications

(52 citation statements)

References 47 publications

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“…34 Authors report that with increased resistance to subsidence, an early motion protocol can be used. 34 The results of this study showed that SBS is biomechanically superior to the LRTI procedure in withstanding metacarpal subsidence in simulated physiological pinch and incremental metacarpal loading immediately following the procedure supporting an early motion protocol. In addition, the trapezial space height decreased in a linear fashion as the metacarpal was incrementally loaded in both groups.…”

Section: Discussionmentioning

confidence: 99%

“…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).…”

mentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“…The manuscripts that formed the major portion of the review (n = 22) include those focused on arthroscopic débridement or partial trapeziectomy with case series and adequate outcomes data (n = 11) [2,9,14,15,17,18,21,25,27,28,34]; open series that provided information regarding the interposition material or changes in the STT joint or MCP hyperextension (n = 7) [8,10,23,[31][32][33]39]; and review or techniques articles or a case study with some limited original clinical data (n = 4) [4,5,12,41].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Those who underwent partial or complete trapeziectomy also were pinned with a temporary Kirschner wire. Yao and Park [41] [39] described resurfacing with costal cartilage autograft from the ninth rib without stabilization. Of 88 patients with minimum followup of 4 months (mean, 68 months; range, 4-159 months), seven patients had persistent pain (five required revision to trapeziectomy, two required recontouring of the graft), and four cases of complex regional pain syndrome (CRPS) and one pleural wound were noted.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Seven manuscripts in the literature described outcomes in patients treated with hemiresection of the trapezium and interposition of an Artelon 1 spacer. This material has been described for interposition arthroplasty arthroscopically [1,3,4,41]. However, because of the paucity of manuscripts available for evaluation of arthroscopic interposition of this material, use of this material in open procedures without ligament stabilization were also reviewed in addition to two level V manuscripts [4,41].…”

Section: Manufactured Materialsmentioning

confidence: 99%

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Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Adams

2014

Clinical Orthopaedics &Amp; Related Research

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Background Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation. Questions/purposes A systematic review was performed to determine the influence of (1) interposition material (manufactured, biological, or none); and (2) patient-related factors (including metacarpophalangeal joint hyperextension, ligamentous laxity, and severity of arthritis) on pain, functional scores, and postoperative complications unique to each approach.Methods A systematic review of the English language literature regarding thumb basilar joint arthritis and arthroscopic partial trapeziectomy or débridement was performed. Those procedures including ligament reconstruction or stabilization were excluded. Results Biological materials and no interposition were both associated with satisfactory improvement and low rates of complications; complication rates with synthetic materials were higher. Eaton Stages I to III were treated successfully with this technique. The effect of scaphotrapeziotrapezoid (STT) changes was variably described across series. In most series, metacarpophalangeal hyperextension did not seem to have an adverse effect on outcomes, although these patients were excluded in some series. Conclusions Arthroscopic débridement with or without interposition can be used for treatment of Eaton Stages I to III CMC osteoarthritis with satisfactory outcomes. Some series suggest satisfactory outcomes in the setting of STT changes and metacarpophalangeal hyperextension.

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Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

Talley¹,

Yao²

2014

Wrist and Elbow Arthroscopy

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Early Treatment of Degenerative Arthritis of the Thumb Carpometacarpal Joint

Cited by 70 publications

References 47 publications

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

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

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

Suture-Button Suspensionplasty for the Treatment of Thumb Carpometacarpal Joint Arthritis

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