Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy

Abstract

Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05. Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p ¼ 0.004). Conclusion Sectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.

Trapeziometacarpal Dislocations in Pediatric Age, Is There a Better Treatment? Series of Cases and a Systematic Review

“…In the same vein, Pellegrini [8] observed that degeneration of the AOL allows increased forces through the joint, leading to progressive joint laxity and subluxation of the metacarpal over the trapezium. In contrast, other studies suggest that the dorsal complex (DRL, DCL, and POL) is the fundamental stabilizing element [9]. Lamas [10] attributed a greater role to the DRL portion.…”

First Carpometacarpal Joint Instability: Dorsal Ligament Reconstruction

“…1). 18,19 Together, the DRL, DCL, and POL have a deltoid shape, fanning out toward the first metacarpal base. The DRL is proposed to be the thickest and widest ligament attaching to the trapezium with a course running slightly obliquely to the insertion on the dorsoradial aspect of the first metacarpal base.…”

Die Daumensattelgelenksarthrose – Aspekte zur Indikationsstellung von Resektionsarthroplastik und Daumensattelgelenksprothese

“…Die zunehmende Verbesserung der arthroskopischen Techniken mit immer kleineren Instrumenten ermöglicht auch die Spiegelung des CMC I-Gelenkes. Einen neuen Therapieansatz in frühen Statdien der Rhizarthrose stellt die Arthroskopie mit Synovektomie und thermalem Shrinking der Kapsel sowie der elongierten Ligamente dar, wobei bisher noch keine Studien mit größeren Patientenzahlen und längerfristigen Ergebnissen vorliegen [11].…”