Meniscal Allograft Arthroplasty for the Treatment of Trapeziometacarpal Arthritis of the Thumb

Shapiro, Paul; Diao, Edward; Givens, Lynn M.

doi:10.1007/s11552-014-9737-4

Cited by 6 publications

(9 citation statements)

References 60 publications

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“…Surgical treatments for thumb CMC OA include first metacarpal osteotomy, trapezial osteotomy, arthrodesis, trapeziectomy, ligament reconstruction and tendon interposition (LRTI), hematoma distraction arthroplasty, bone or soft tissue interposition arthroplasty, and joint-replacement arthroplasty. 4,5,[8][9][10][11]13,15,21,22,[24][25][26] All these techniques have been found to mitigate symptoms and improve function, but an "ideal" procedure that not only alleviates pain but also preserves the length, stability, strength, and normal function of the thumb, while avoiding the morbidity associated with tendon harvest, has not yet been established.…”

Section: Introductionmentioning

confidence: 99%

Thumb Metacarpal Subsidence After Partial Trapeziectomy With Capsular Interposition Arthroplasty

Salas

Mercer

O’Mahony

et al. 2016

Hand (New York, N,Y.)

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In a cadaveric model, we evaluated thumb metacarpal subsidence, indicated by a decreased metacarpal-to-scaphoid distance, after 2 surgical procedures used to treat thumb carpometacarpal (CMC) osteoarthritis (OA): partial trapeziectomy with capsular interposition (PTCI), which involves removal of 2 mm of both the distal trapezium and base of the metacarpal; and total trapeziectomy with capsular interposition (TTCI). Nine matched pairs of cadaveric hands were randomly assigned to undergo either PTCI or TTCI. Preoperatively, physiologic forces were applied across the thumb CMC joint by loading 6 tendons, simulating lateral pinch. Anteroposterior radiographs were obtained, and the metacarpal-to-scaphoid distance on each image was estimated independently by 3 separate readers using customized software. A hand surgeon then performed the PTCI and TTCI procedures, and the measurements under loading were repeated. The results were assessed for interrater reliability. Mean values for metacarpal-to-scaphoid distance before and after the surgical procedures were compared. Preoperatively, the metacarpal-to-scaphoid distance in the PTCI and TTCI groups was not significantly different. Postoperatively, metacarpal subsidence was significantly less in the PTCI group (17% compared with 34% for TTCI; = .05). Metacarpal subsidence occurred after both PTCI and TTCI, but significantly less subsidence was observed after PTCI; thus, thumb length was better preserved. Previous research has shown an inverse correlation between maintenance of thumb length and overall Disabilities of the Arm, Shoulder, and Hand (DASH) score. A procedure for treating thumb CMC OA that preserves thumb length and minimizes disruption of stabilizing joint tissue may provide enhanced maintenance of thumb stability and improved patient outcomes.

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Section: Introductionmentioning

confidence: 99%

Thumb Metacarpal Subsidence After Partial Trapeziectomy With Capsular Interposition Arthroplasty

Salas

Mercer

O’Mahony

et al. 2016

Hand (New York, N,Y.)

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“…At approximately $1200 USD for a full meniscus, it is comparable to other currently used implants, for example, the pyrocarbon spacer, PI2 (Tornier Bioprofile, Grenoble, France) which retails for € 930 European, the Arthrex mini-tightrope (Arthrex, Inc, Naples, Fla.) at approximately $1000 USD, the GraftJacket acellular dermal matrix (Wright Medical Group, Memphis, Tenn.) between $1000 and 3000 USD, and the titanium hemiarthroplasty implant at approximately $2000 USC (Wright Medical Group). 24 , 55 Tailored smaller MAT sizes specific to the hand and small digit joint space may further reduce the cost of the meniscus allograft and maximize the use of the donated human tissue. Studies have demonstrated a cost-effectiveness of arthroplasty using pyrocarbon implants in rheumatoid patients with MCP joint arthroplasty in terms of repeat operations and overall utilization of the healthcare system.…”

Section: Discussionmentioning

confidence: 99%

“… 22 Although predominantly used in the lower extremity, Nanavati et al 23 first described the use of MAT for proximal carpectomy in the hand. More recently, Shapiro et al 24 described the use of MAT for interposition arthroplasty in trapeziometacarpal arthritis, and Hoang et al 25 described it for resurfacing of metacarpal phalangeal and proximal interphalangeal joints of the hand. However, further studies regarding clinical outcomes are lacking.…”

Section: Introductionmentioning

confidence: 99%

Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand

McCullough

Minasian

Tanabe

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Osteochondral defects of the carpometacarpal (CMC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints often necessitate arthrodesis or arthroplasty. Meniscal allograft has been used for large joint resurfacing, but its application to smaller joints is less well understood. We propose its use for hand joint resurfacing as an off-the-shelf alternative to address osteochondral defects and restore articular function. Methods: Thirty-one patients with osteoarthritis of the CMC, MCP, or PIP joints underwent arthroplasty with meniscal allograft. Patient demographics and operative information were recorded. Preoperative Disability of the Shoulder, Arm, and Hand, Wong Baker pain, grip and pinch strength, and range of motion were compared to postoperative scores at 6 weeks, 6 months, and 1 year. Results: Twenty-three women and 8 men, mean age 62.8 years, underwent 39 joint reconstructions, including CMC (n = 26), thumb MP (n = 2), thumb IP (n = 2), digit MP (n = 2), and digit PIP (n = 7). At 1 year, mean Disability of the Shoulder, Arm, and Hand scores decreased from 41.3 to 15.6 ( P < 0.001) and pain scores from 6.9 to 1.0 ( P < 0.001). Grip strength increased from 38.1 to 42.9 ( P = 0.017) and radial and palmar abduction from 43.1 to 49.2 ( P = 0.039) and 43.7 to 51.6 ( P = 0.098), respectively. There were no complications related to the meniscus. Conclusions: Meniscal allograft represents an alternative to arthrodesis which obviates the need for a donor site and avoids many of the complications inherent to synthetic alternatives. Our early results demonstrate its successful use to reduce subjective pain and disability scores, improve objective strength measures, and maintain range of motion.

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“…28 While predominantly used in the lower extremity, Nanavati et al 30 first described the use of MAT for proximal carpectomy in the hand. More recently, Shapiro et al 31 described the use of MAT for interposition arthroplasty in CMC arthritis, and Hoang et al 32 described it for resurfacing of metacarpal phalangeal and proximal interphalangeal joints of the hand. However, further studies regarding clinical outcomes, including strength and range of motion measures, as well as patient-reported pain and disability scores, are lacking.…”

Section: Introductionmentioning

confidence: 99%

Functional Outcomes for Basilar Joint Arthroplasty with Meniscus Allograft Compared with Trapeziectomy Alone

McCullough

Minasian

Tanabe

et al. 2021

Hand (New York, N,Y.)

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Background Advanced thumb carpometacarpal (CMC) joint arthritis is widely treated with trapeziectomy. To obviate the need for autologous tissue, maintain thumb length, and reduce the risk of scaphoid impingement, the senior author developed an interposition arthroplasty technique using meniscal allograft. We hypothesize that the use of meniscus improves outcomes and subsequent functionality compared with trapeziectomy alone. Methods Twenty-three patients with Eaton stage III-IV CMC osteoarthritis underwent arthroplasty with meniscal allograft, and 7 patients underwent trapeziectomy alone. Preoperative Disabilities of the Arm, Shoulder, and Hand (DASH), pain, grip and pinch strength, and range of motion scores were compared with postoperative scores at 6 weeks, 6 months, and 1 year. Results The study group consisted of 17 women and 6 men, and the control group consisted of 5 women and 2 men. The mean age was similar at 61.4 (48-72) years and 65.7 (56-78) years for the study and control groups, respectively. The DASH scores dropped by 61.8% in the study group compared with 38.8% in the control group (<0.01), whereas pain decreased 86.0% and 69.8%, respectively ( P < .01). Strength and range of motion improvement was similar between the groups. Subsidence of the joint space was 1% in the study group compared with 18.4% in the control group. There were no surgical complications in either group. Conclusions Joint resurfacing with meniscal allograft represents a viable joint salvage option in severe cases of CMC arthritis. Early results suggest that, compared with trapeziectomy alone, the approach results in greater reduction in subjective pain and disability scores, similar improvement in strength measures and range of motion, and less subsidence.

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Meniscal Allograft Arthroplasty for the Treatment of Trapeziometacarpal Arthritis of the Thumb

Cited by 6 publications

References 60 publications

Thumb Metacarpal Subsidence After Partial Trapeziectomy With Capsular Interposition Arthroplasty

Thumb Metacarpal Subsidence After Partial Trapeziectomy With Capsular Interposition Arthroplasty

Functional Outcomes for Meniscal Allograft Interposition Arthroplasty of the Hand

Functional Outcomes for Basilar Joint Arthroplasty with Meniscus Allograft Compared with Trapeziectomy Alone

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