Suture Suspensionplasty Using Abductor Pollicis Longus and Flexor Carpi Radialis for Advanced Thumb Carpometacarpal Joint Arthritis

Abstract

Purpose Current operative treatment for advanced thumb carpometacarpal (CMC) joint arthritis mainly constitutes complete trapeziectomy with or without additional stabilizing procedures. However, it is unclear whether the additional procedures influence overall clinical outcomes. Therefore, the purpose of this study was to evaluate the effectiveness of our posttrapeziectomy suture suspensionplasty technique, performed using the abductor pollicis longus and flexor carpi radialis tendons, in patients with advanced thumb CMC arthritis. Materials and Methods We evaluated 36 thumbs of 35 patients with advanced thumb CMC arthritis treated with combined operative excision of trapezium followed by a suture suspensionplasty using flexor carpi radialis and abductor pollicis longus tendons. We used a minimal volar approach to create a sling construct with a nonabsorbable suture material, which could support the thumb metacarpal base without pin fixation or tendon transfer. For radiographic evaluation, we used the ratio of the radial metacarpal subluxation to metacarpal articular width, estimated from the bilateral stress-view radiographic images of the thumb, and calculated the trapezial space ratio by dividing the trapezial space height by the proximal phalangeal length. The clinical outcomes were evaluated using the visual analog scale and disabilities of the arm, shoulder, and hand scores, along with evaluation of the improvement in both postoperative range of motion and strength recovery. Results The mean duration of follow-up was 26 months (range, 18–60 months). The average visual analog scale and disabilities of the arm, shoulder, and hand scores decreased from 5.9 to 0.4 and from 51.6 to 27.0, respectively. The range of motion during palmar abduction and opposition of the metacarpophalangeal joint improved with an increase in mean value from 49.1 degrees to 54.1 degrees, and from 7.8 to 9.3 Kapandji score, respectively. The grip and key pinch strengths showed no significant changes from mean preoperative values of 13.3 kg and 3.8 kg to 13.2 kg and 3.2 kg, respectively, as measured at the 18-month follow-up. Conclusions Our suture suspensionplasty technique has several advantages including minimal invasive approach, short operative time, cost-effectiveness, and early mobilization. We suggest that it can be used as an effective, alternative stabilization method after a complete trapeziectomy.

Selective Denervation for the Thumb Carpometacarpal Joint

“…Although trapeziectomy has been known for successful outcomes with marked pain relief and functional outcomes, it has a limitation in that it cannot gain strength equal to that of the contralateral side. 20 However, in our study, patients regained the grip and pinch strength almost close to the normal range during the 12-month follow-up. Thus, selective denervation has a significant advantage in preserving joint function.…”

“…At approximately 2.5 cm, a curvilinear skin incision was made at the junction of the glabrous and nonglabrous skin, extending from the proximal edge of the base of the CMC joint to the radial end of the volar wrist crease, and careful dissection of the thenar muscle fascia was performed (Figs. 2A, B) 20 . First, the volar aspect of the joint was exposed by reflecting thenar muscle from proximal insertion on the volar border of the first metacarpal and trapezium.…”

“…2A, B). 20 First, the volar aspect of the joint was exposed by reflecting thenar muscle from proximal insertion on the volar border of the first metacarpal and trapezium. The PCBMN that travels through the floor of the thenar muscle was identified (Fig.…”

Arthroscopic Trapeziectomy

“…Since then, myriad procedures have been described ranging from simple trapeziectomy plus distraction pinning, ligament reconstruction, interposition arthroplasty, sling formation, and suture button suspension. [3][4][5][6][7][8] A survey reported by the American Society for Surgery of the Hand has noted that the majority of hand surgeons practicing in the United States still most commonly prefer ligament reconstruction with tendon interposition despite the evidence that it has been shown to have similar results to simple trapeziectomy. 9 Even though the variety of procedures described to treat CMC joint arthrosis is expansive, one common thread most share is that the trapezium is removed.…”

“…Trapeziectomy was first described by Gervis2 in 1949 as a treatment for pain caused by basal joint degenerative disease. Since then, myriad procedures have been described ranging from simple trapeziectomy plus distraction pinning, ligament reconstruction, interposition arthroplasty, sling formation, and suture button suspension 3–8. A survey reported by the American Society for Surgery of the Hand has noted that the majority of hand surgeons practicing in the United States still most commonly prefer ligament reconstruction with tendon interposition despite the evidence that it has been shown to have similar results to simple trapeziectomy 9…”