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

Abstract

Background Thumb carpometacarpal (CMC) joint arthritis is a common problem in clinical practice with a variety of treatment options. Arthroscopic procedures can preserve all or part of the trapezium in the setting of treatment of basilar joint arthritis, and such procedures (even without stabilization or ligament reconstruction) have high reported success rates. However, little is documented about the limitations of these procedures in terms of patient selection, the optimal type of interposition, if any, and rehabilitation. Questions/purposes A systematic review was performed to determine the influence of (1) interposition material (manufactured, biological, or none); and (2) patient-related factors (including metacarpophalangeal joint hyperextension, ligamentous laxity, and severity of arthritis) on pain, functional scores, and postoperative complications unique to each approach.Methods A systematic review of the English language literature regarding thumb basilar joint arthritis and arthroscopic partial trapeziectomy or débridement was performed. Those procedures including ligament reconstruction or stabilization were excluded. Results Biological materials and no interposition were both associated with satisfactory improvement and low rates of complications; complication rates with synthetic materials were higher. Eaton Stages I to III were treated successfully with this technique. The effect of scaphotrapeziotrapezoid (STT) changes was variably described across series. In most series, metacarpophalangeal hyperextension did not seem to have an adverse effect on outcomes, although these patients were excluded in some series. Conclusions Arthroscopic débridement with or without interposition can be used for treatment of Eaton Stages I to III CMC osteoarthritis with satisfactory outcomes. Some series suggest satisfactory outcomes in the setting of STT changes and metacarpophalangeal hyperextension.

Arthroscopic Synovectomy Combined with Autologous Fat Grafting in Early Stages of CMC Osteoarthritis of the Thumb

“…20 Arthroscopy can be supplemented by interposition of different biological or manufactured materials. [4][5][6]17 Poly-L-lactic acid (PLLA) implant is a common synthetic interposition material. Pereira et al 3 provided controversial results by combining PLLA with arthroscopy in their long-term follow-up study.…”

“…Artificial interposition materials such as polylactic acid implants or Gore-Tex products were introduced while biological interposition tissues such as autologous tendon grafts, allogenic fascia lata or acellular dermal matrix grafts are still in use. 4 Synthetic interposition material has the disadvantage of high costs and possible inflammatory or allergic reactions. 5,6 Herold et al first published autologous fat grafts in the thumb CMC joint.…”

Management of Osteoarthrosis of the Thumb Joints

“…Partial or total trapeziectomy performed arthroscopically is possible. 14 Adams' 14 systematic review of arthroscopy for TMC arthritis identified 11 articles describing arthroscopic debridement or partial trapeziectomy. Patient outcomes were satisfactory across series.…”

Nykščio riešinio sąnario artrozės gydymas atvirąja sinovektomija su sąnario išvalymu: vėlyvųjų pooperacinių gydymo rezultatų įvertinimas

“…Studijose fiksuoti labai aukšti pacientų subjektyvaus pasitenkinimo įverčiai. 2014 m. atlikta sisteminė apžvalga parodė, kad artroskopinė sinovektomija su sąnario išvalymu ir su interpozicija (ar be jos) gali būti sėkmingai taikoma I-III stadijos NRS osteoartritui gydyti [14]. Ši metodika yra mažiau invazyvi negu atviroji sinovektomija, tačiau artroskopinė technika turi nemažai apribojimų ir keliamų rizikų.…”

“…Atlikta literatūros analizė parodė, jog sinovektomijos su sąnario išvalymu tema iki šiol paskelbta tik artroskopiškai atliktų gydymo procedūrų (N = 2) mokslinių duomenų [12,13]. Sisteminė apžvalga, įvertinus artroskopinės sinovektomijos ir hemitrapezektomijos su interpozicija (ir be jos) gydymo rezultatus gydant NRS osteoartritą, atskleidė, jog visi šie rezultatai, išskyrus aptartus vienoje studijoje [24], yra teigiami tiek klinikiniu, tiek funkciniu atžvilgiu [14]. Daugelyje studijų nurodomas pincetinio, šoninio gnybio ir plaštakos sugriebimo jėgos pagerėjimas.…”