Arthroscopic Trapeziectomy Without Traction Tower

Abstract

Osteoarthritis in the thumb carpometacarpal joint causes pain, swelling, deformity, instability, loss of motion, and power, which seriously impairs overall hand function. Surgery is indicated if conservative treatment fails to relieve the pain. Trapeziectomy is the most popular surgical treatment choice and yields good range of motion and relieves pain with the fewest complications. Arthroscopic trapeziectomy is gaining popularity. In general, the arthroscopic procedure is performed under continuous traction with a traction tower. The purpose of this Technical Note is to describe the details of arthroscopic trapeziectomy without traction tower. This eliminates the need of a traction tower and continuous traction and provides a stable platform for the arthroscopic procedure.

Fig 1

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. In this illustrated case, radiograph shows osteoarthritis of the thumb carpometacarpal joint and scaphotrapeziotrapezoid joint. CMCJ, thumb carpometacarpal joint; STTJ, scaphotrapeziotrapezoid joint.

Fig 2

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. The procedure is performed via the 1U portal and the thenar portal of the thumb carpometacarpal joint. 1UP, 1U portal; TP, thenar portal.

Fig 3

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. The 1U portal is the viewing portal, and the thenar portal is the working portal. (A) The capsule of the thumb carpometacarpal joint between the portals is resected with an arthroscopic shaver to expose the joint. (B) Trapeziectomy is started at the distal radial edge of the trapezium bone by means of an arthroscopic acromionizer. The bone resection is from outside the joint to inside the joint. Tm, trapezium; MC, first metacarpal; AA, arthroscopic acromionizer.

Fig 4

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. The thenar portal is the viewing portal and the 1U portal is the working portal. (A) The ulnar osteophyte of the trapezium bone is dissected and lifted out from between the first and second metacarpal bases by means of the shaver. (B) The osteophyte and the ulnar half of the trapezium bone are resected till the trapezoid bone is exposed, which represent the ulnar boundary of the bone resection. Tm, trapezium; MC, first metacarpal; Os, ulnar osteophyte of the trapezium; Tz, trapezoid.

Fig 5

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. The 1U portal is the viewing portal and the thenar portal is the working portal. The bone resection is proceeding proximally with the shaver. When the proximal subchondral bone is reached, the subchondral bone is removed by a Kerrison rougeur to expose the scaphoid bone. This represents the proximal boundary of the bone resection. Tm, trapezium; S, scaphoid.

Fig 6

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. The 1U portal is the viewing portal and the thenar portal is the working portal. During bone resection of the volar part of the trapezium, the flexor carpi radialis tendon is in view. The bone around the tendon is carefully removed with an arthroscopic punch. FCR, flexor carpi radialis tendon.

Fig 7

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in supine position with the hand on the side table. The 1U portal is the viewing portal. After the arthroscopic bone resection, the completeness of trapeziectomy can be assessed arthroscopically. FCR, flexor carpi radialis tendon; Tz, trapezoid; S, scaphoid.

Fig 8

Arthroscopic trapeziectomy of the left wrist without traction tower. The patient is in the supine position with the hand on the side table. (A) After total trapeziectomy, suture-button suspensionplasty stabilizing the first metacarpal base to the second metacarpal is performed with the Mini TightRope (Arthrex, Naples, FL). (B, C) The thenar portal is used for insertion of the guidewire and insertion of suture-button. GW, guide wire; Su, suture; TP, thenar portal; B, button.