Arthroscopic Interposition Arthroplasty of the First Carpometacarpal Joint

Abstract

First carpometacarpal joint arthritis is a common condition encountered by hand surgeons. Traditionally, surgical approaches have included arthrodesis, trapeziectomy or reconstructive arthroplasty techniques. Previously, we described a technique for arthroscopic debridement and interposition arthroplasty of the first carpometacarpal joint. Patients with Eaton stages II and III symptomatic first carpometacarpal joint arthritis recalcitrant to >6 months of non-operative therapy underwent arthroscopic debridement of the first carpometacarpal joint with interposition of an acellular dermal matrix allograft (GRAFTJACKET). In this paper, we describe outcomes following this procedure. Postoperatively, all patients reported symptomatic relief and 94% stated that they were partially, or completely, satisfied. More than 70% of patients reported no to mild difficulty in performing activities of daily living (average grip strength = 18.5 kg, pinch strength = 3.9kg). Complications were minimal. Outcomes from this study compare favourably to those of other series, demonstrating that this technique is a viable option for treatment of Eaton stages II and III first carpometacarpal arthritis.

Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?

“…Most series suggest improvement in pinch and grip strength, although one [2] demonstrated no statistically significant difference in pre-and postoperative values. In contrast, another series [21] documented statistically significant improved pinch strength but not grip strength.…”

“…The manuscripts that formed the major portion of the review (n = 22) include those focused on arthroscopic débridement or partial trapeziectomy with case series and adequate outcomes data (n = 11) [2,9,14,15,17,18,21,25,27,28,34]; open series that provided information regarding the interposition material or changes in the STT joint or MCP hyperextension (n = 7) [8,10,23,[31][32][33]39]; and review or techniques articles or a case study with some limited original clinical data (n = 4) [4,5,12,41].…”

“…A variety of allograft and autograft native and processed materials have been used as interposition materials, including autologous abductor pollicis longus tendon, palmaris longus, part of the flexor carpi radialis tendon, allogeneic fascia lata, and allogeneic cellular dermal matrix allograft [2,3,5,15,25,27,28,34,41].…”

“…Two of these patients had persistent pain; this was believed to be associated with absorption of the implant and failure and use was believed to be inferior to autologous implants [28]. Use of acellular dermal matrix graft (GraftJacket TM ; Wright Medical, Arlington, TN, USA) resulted in a high rate of satisfactory outcomes in one series [2].…”

“…Yao and Park included those with MCP hyperextension but addressed those patients with [ 20°of hyperextension deformities with fusion or capsulodesis [41]. Others included those with MCP hyperextension [2,25,27,28,39] but in two reports by one author, it was suggested that MCP hyperextension was associated with weakness of pinch or failures of the procedure, although six of nine patients with preoperative MCP hyperextension did not have complaints [27,28]. In contrast, the other series have noted no such association [2,25,39].…”