Natural History of Metacarpal Subsidence following Trapeziectomy and Its Relationship to Clinical Outcomes

Abstract

Methods: An institutional review board–approved retrospective review of patients who underwent trapeziectomy and ligament reconstruction and tendon interposition (LRTI) was conducted. Patient demographics, visual analogue scale pain scores, grip strength, pinch strengths, and radial and palmar abduction were collected. The trapezial space ratio (TSR) was measured by the scaphometacarpal distance divided by the length of the capitate. Subsidence [(postoperative TSR − preoperative TSR)/preoperative TSR] was measured and classified as severe (≥70%) or mild to moderate (<70%). Median rate of subsidence increase was calculated. Conolly-Rath scores were used to evaluate the proportion of good outcomes in each group. Results: A total of 141 trapeziectomies with LRTI were included. Subsidence increased 6.7% (5.4% to 23.0%) per week before 16 weeks and 0.3% (0.1% to 0.8%) per week thereafter. Visual analogue scale pain scores were not significantly different between patients with severe or mild to moderate subsidence (P = 0.25) 16 weeks after thumb mobilization. The proportion of good outcomes was comparable between the two groups (P = 0.12). There was no correlation between subsidence and pain (ρ = −0.20; P = 0.24), grip (ρ = −0.02; P = 0.93), key (ρ = −0.13; P = 0.62), tripod (ρ = 0.16; P = 0.71), or index tip pinch strengths (ρ = −0.28; P = 0.43) or radial (ρ = −0.03; P = 0.92) or palmar (ρ = −0.15; P = 0.61) abduction. Conclusions: Subsidence occurs in all patients after trapeziectomy and LRTI, stabilizing 16 weeks after mobilization. Degree of subsidence does not correlate with postoperative outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Trapezial Resection Arthroplasty: More Is Not Necessarily Better

“…found that subsidence occurs in patients with trapeziectomy and concurrent LRTI up to 16 weeks post-operative, and does not result in any differences in post-operative pain, range of motion, or grip and key/pinch strength [25]. Thus, it is unclear whether these adjunctive procedures confer additional benefit in preventing subsidence.…”

Re: Lui H, Galbraith JG, Meyers K, Bindra R, Lee SK. Biomechanical analysis of three techniques of suspensionplasty after trapeziectomy: a cadaveric study. J Hand Surg Eur. 2023, doi:10.1177/17531934231186495

“…Meyers et al. (2023) reviewed 141 trapeziectomies with ligament reconstruction and tendon interposition (LRTI) and reported that subsidence occurs in all patients after trapeziectomy and LRTI but that the degree of subsidence does not correlate with postoperative symptoms. Molin et al. (2022) retrospectively examined 91 thumbs in 65 patients after a mean of 10 years after trapeziectomy with and without LRTI.…”

“…In a number of studies directly comparing pain, function and quantitative subsidence, there is no consistent evidence that proximal migration of the first metacarpal is associated with continued symptomatology or poor function. Meyers et al (2023) reviewed 141 trapeziectomies with ligament reconstruction and tendon interposition (LRTI) and reported that subsidence occurs in all patients after trapeziectomy and LRTI but that the degree of subsidence does not correlate with postoperative symptoms. retrospectively examined 91 thumbs in 65 patients after a mean of 10 years after trapeziectomy with and without LRTI.…”