Efficacy of Abductor Pollicis Longus Suspension Arthroplasty Combined With Mini TightRope for Osteoarthritis of Thumb Carpometacarpal Joint

Abstract

Background: We aimed to evaluate the efficacy of abductor pollicis longus (APL) suspension arthroplasty with trapeziectomy combined with first and second metacarpal fixation using suture button device.

Methods: Thirteen patients (14 thumbs) who underwent APL suspension arthroplasty combined with suture button device for osteoarthritis of the carpometacarpal joint of the thumb (Eaton grade III: 6 and IV: 8 thumbs) at our institution between 2015 and 2019 and were followed up for more than 24 months were included in the study. Preoperative and postoperative range of motion (ROM) of radial and palmar abduction, grip and key pinch strength, visual analog scale (VAS) scores for pain, and the trapezial space ratio (TSR) on radiographic images before and after surgery were statistically examined.

Results: The mean age of the patients was 59.6 ± 8.1 years, and the mean follow-up period was 45.4 ± 12.2 months. While grip and pinch strength did not significantly change between preoperative and final follow-up measurements, the ROM of radial and palmar abduction and the VAS score at the latest follow-up were significantly better than the preoperative values (P < .05). The mean TSR immediately after surgery and at the latest follow-up was 0.28 ± 0.089 and 0.22 ± 0.084, respectively, indicating a mean reduction rate of 23.3 ± 15.2%.

Conclusions: This surgical technique showed significant improvement in the ROM of radial and palmar abduction and the VAS score for pain, and the combined fixation of the first and second metacarpals with suture button device suppressed the subsidence of the first metacarpal.

Keywords: suspension arthroplasty; suture button device; thumb carpometacarpal arthritis.

Figure 1.

Method of calculating trapezial space ratio (TSR). TSR is calculated as the ratio of the height of the trapezius space (B) to the length of the first proximal phalanx (A).

Figure 2.

APL suspension arthroplasty in combination with first and second metacarpal fixation using the suture button device. Note. APL = abductor pollicis longus; S = scaphoid; Td = trapezoideum; I = first metacarpal; II = second metacarpal; ☆ = trapeziectomy. 1. Pass the APL tendon from the bone hole in the first metacarpal to the bone hole in the second metacarpal. 2. Fix the tendon with a tenodesis screw on the proximal side of the second metacarpal. 3. Fix the first and second metacarpals using a suture button device.