Surgical management of basal Joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplast

Burton, Richard I.; Pellegrini, Vincent D.

doi:10.1016/s0363-5023(86)80137-x

Cited by 633 publications

(403 citation statements)

References 46 publications

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“…43 In the treatment of symptomatic advanced degenerative osteoarthritis of the thumb saddle joint, trapeziectomy with or without ligament reconstruction is the gold standard. 14,18,44,45 Faster rehabilitation and higher pinch grip are arguments that favor the use of prosthetic replacement. 20 This study demonstrated that the remaining bone stock in the trapezium, even in advanced osteoarthritic stages, is sufficient to adequately host an implant.…”

Section: Discussionmentioning

confidence: 99%

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Nufer

Goldhahn

Köhler

et al. 2007

Journal Orthopaedic Research

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Although the thumb saddle is one of the most common sites of degenerative osteoarthritis in the hand, little is known about the altered microstructure in osteoarthritic trapezial bones. External forces resulting from subluxation of the carpometacarpal joint of the thumb (CMC I) should provoke microstructural changes in the trapezium. The purpose of this study was to compare the regional differences of the microstructure between osteoarthritic and healthy trapezial bones. Fifteen trapezia harvested from female patients with radiologically and clinically diagnosed saddle joint osteoarthritis (OA) were compared with 15 unaffected controls. Microstructural parameters, such as bone volume ratio (BV/TV), three-dimensional connectivity (Conn.D), trabecular number (Tb.N), and trabecular thickness (Tb.Th) were studied using a microcomputed tomography (microCT) system. While the trapezial height in OA was 22% less, the sclerotic subchondral bone layer thickness was 50% higher in OA compared with the control group (p < 0.001). In the OA group there was a 42% higher bone volume ratio (p 0.001), an 18% increase in Tb.Th (p ¼ 0.006), and a 10% greater Tb.N (p ¼ 0.034) compared with the control group. Although in both groups BV/TV was significantly lower in the radial region, the radial column showed the highest relative increase in bone volume and structure compared with the control group (þ67% BV/TV, þ20% Tb.Th, þ23% Tb.N). The reinforcement of the bony microstructure in CMC I OA, especially at the radial side, is a sign for bone adaptation reacting to radially shifted joint forces. This has to be considered during the development of new prosthetic alternatives. ß

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Section: Discussionmentioning

confidence: 99%

Microstructural adaptation in trapezial bone due to subluxation of the thumb

Nufer

Goldhahn

Köhler

et al. 2007

Journal Orthopaedic Research

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“…Each LRTI was performed using the technique described by Burton and Pellegrini. 3 The SBS group underwent a trapeziectomy and SBS using the Mini TightRope (Arthrex) as described by Cox et al 6 Each specimen was then mounted using a clamp holding the proximal radius and ulna. We used previously described and validated testing protocols to simulate key pinch of approximately 32 N. 4,17,22,23 Load was applied using fishing line and weights attached to the sutures in each muscle-tendon unit (EPL: 2.5 lbs; EPB: 2.5 lbs; AP: 2.5 lbs; FPL: 5 lbs; total: 12.5 lbs) as described by Putnam et al to generate pinch ( Figure 2).…”

Section: Methodsmentioning

confidence: 99%

“…Surgical options include volar ligament reconstruction, 11 first metacarpal osteotomy, 13 CMC joint arthrodesis, 12 total joint arthroplasty, 1 and trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI). 3,9 Comparative studies have shown no significant long-term difference in outcomes among these techniques, 18,[29][30][31] aside from a lower complication rate 30,31 and shorter operative time with trapeziectomy alone. 20 The use of a suture-button suspensionplasty (SBS) with trapeziectomy has grown in popularity.…”

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confidence: 99%

Biomechanical Comparison of Suture-Button Suspensionplasty and LRTI for Basilar Thumb Arthritis

Desai

Brogan

Richard

et al. 2016

Hand (New York, N,Y.)

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Surgery ArticleOsteoarthritis (OA) at the base of the thumb can cause severe pain, weakness, and deformity and can result in marked disability. 14 The unique anatomy of the thumb carpometacarpal (CMC) joint predisposes it to degenerative arthritis. 5,27 Specifically, the degree of weakening of the palmar beak ligament has been correlated with degenerative processes in the joint and is the target of ligament reconstruction for symptomatic arthritis. 7 Degenerative OA at the thumb CMC joint is treated initially with activity modification, splinting, medication, and intra-articular corticosteroid injections. 34 For advanced disease, or when nonoperative treatments have failed, surgical intervention can be considered. Surgical options include volar ligament reconstruction, 11 first metacarpal osteotomy, 13 CMC joint arthrodesis, 12 total joint arthroplasty, 1 and trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI). 3,9 Comparative studies have shown no significant long-term difference in outcomes among these techniques, 18,[29][30][31] aside from a lower complication rate 30,31 and shorter operative time with trapeziectomy alone. 20 The use of a suture-button suspensionplasty (SBS) with trapeziectomy has grown in popularity. 6,24,35,36 Advocates of this technique cite safety, ease of use, early mobilization, and good early results. 35,36 However, it is not known how effectively the SBS withstands metacarpal subsidence under loaded conditions. The purpose of this study was to biomechanically compare the more widely adopted LRTI procedure with SBS using a cadaveric model. We hypothesize that the SBS will result in a biomechanically stronger construct with immediate loading. Demonstration of an enhanced ability to withstand early active pinch while preventing metacarpal subsidence may support early motion rehabilitation protocols. Abstract Background: The purpose of this study was to compare the initial biomechanical strength of trapeziectomy and suturebutton suspensionplasty (SBS) with ligament reconstruction and tendon interposition (LRTI) for thumb carpometacarpal (CMC) arthritis in a cadaveric model. Methods: Eight matched pairs of below-elbow cadaveric arms were used for this study. Each specimen was randomly assigned to either receive a trapeziectomy and LRTI (LRTI group) or trapeziectomy and SBS (SBS group). Using previously described and validated testing protocols, physiological key pinch was simulated. The thumb metacarpal was then incrementally loaded from 5 to 20 lbs, using 5-lb increments. Metacarpal subsidence during physiological key pinch and incremental loading was determined using radiographic measurements of trapezial space height. Results: The average pretesting trapezial space height did not differ significantly between the LRTI (11.9 mm) and SBS (13.7 mm) groups. After simulated physiological key pinch, the SBS group had significantly greater average trapezial space height compared with the LRTI group (8.0 mm vs 5.5 mm). For each incremental metacarpal load from 5...

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“…Autores recomendam a ressecção do trapézio e apenas interposição tendinosa sem reconstrução ligamentar (13)(14)(15)(16) . No entanto, a cirurgia que parece ser a preferida ultimamente é a combinação da trapeziectomia com ligamentoplastia e interposição tendinosa, embora muitos autores concordem com o fato de que a simples ressecção do trapézio dá os mesmos resultados que a associação com aquelas técnicas (2,(17)(18)(19)(20)(21) .…”

Section: Introductionunclassified