Which Tendon Plasty Has the Best Outcome? A Comparison of Four Tendon Plasty Techniques in a Large Cohort of Patients with Symptomatic Trapeziometacarpal Osteoarthritis

Abstract

Background: Trapeziometacarpal osteoarthritis is commonly treated with a trapeziectomy combined with a form of tendon plasty. The type of tendon plasty used is based on the surgeon’s preference. The purpose of this observational study was to compare the outcomes of four different tendon plasties combined with trapeziectomy used to treat osteoarthritis of the trapeziometacarpal joint: the Weilby, Burton-Pellegrini, Zancolli, and anchovy plasty procedures. Methods: Patients treated with a trapeziectomy followed by a tendon plasty completed patient-reported outcome measures at baseline and 12 months postoperatively. The primary outcome was the Michigan Hand Outcomes Questionnaire pain subscale. Secondary outcomes were the minimal clinically important difference of Michigan Hand Outcomes Questionnaire pain scale score, Michigan Hand Outcomes Questionnaire hand function, satisfaction, and complication rate. Results: Seven hundred ninety-three patients underwent a trapeziectomy with a tendon plasty between November of 2013 and December of 2018. There was no difference in pain score after 12 months between the four tendon plasty techniques. Patients undergoing an anchovy plasty had a higher chance of reaching the minimal clinically important difference for Michigan Hand Outcomes Questionnaire pain score compared to the other techniques (OR, 2.3; 95 percent CI, 1.2 to 4.6). Overall, more than 80 percent of the patients were satisfied with the treatment outcome, independent of which technique was used. Complication rates of the different techniques were similar. Conclusions: Surgical treatment of osteoarthritis of the trapeziometacarpal joint reduced pain after 12 months, independent of which tendon plasty was used. Patients undergoing an anchovy plasty were more likely to experience a clinically relevant improvement in pain while having similar hand function, satisfaction, and complication rates. This suggests that anchovy plasty is the preferred tendon plasty. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Stronger pinch strength at long-term follow-up after pyrocarbon disc interposition arthroplasty compared to trapeziectomy with ligament reconstruction and tendon interposition for CMC-1 osteoarthritis.

“…Various surgical treatment strategies are used for CMC thumb joint osteoarthritis, although none has been proven to be superior. 5 , 38 Therefore, simple trapeziectomy is considered the standard, because this technique has fewer complications compared with other common techniques. 5 , 39 The complication ratio after PDI was comparable with LRTI based on this study (12.9%; Table 5 ).…”

Involvement in a Personal Injury Claim Is Associated With More Pain and Delayed Return to Work After Elective Nonsurgical or Surgical Treatment for Hand or Wrist Disorders: A Propensity Score–matched Comparative Study

“…Additionally, only 42% to 55% of patients with personal injury claims experienced a clinically relevant improvement in pain after minor and major surgery, respectively. For example, when we compare this to surgery for thumb base osteoarthritis, we find that a clinically relevant improvement in pain has been reported for 71% to 84% of patients [ 18 , 27 ]. This raises the question of whether patients actually benefit from treatment while they have an ongoing personal injury claim.…”

Basal thumb arthritis surgery: complications and its management

“…In addition, tendon replacement material in the form of an allograft has been used (Marks et al., 2017). None of these interposition materials have proven superiority over each other (Hoogendam et al., 2022), and there is also no clear evidence that suspension and/or interposition is needed to achieve a good treatment outcome, either in the rate of revision or in the pinch strength (Hamasaki et al., 2021; Wajon et al., 2015). While there is some evidence to suggest the suspension technique increases the primary stability of the trapezium resection (Behm et al., 2022), its use must be justified by better clinical outcomes to outweigh the potential morbidity of harvesting and using a tendon or part of a tendon.…”