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Arthroscopic Trapeziectomy with Suture Button Suspensioplasty for Symptomatic Carpo-metacarpal Arthritis
Genevieve Landes, MD; Abdo Bachoura, MD; Sidney M. Jacoby, MD; A. Lee Osterman, MD; Randall W. Culp, MD
Hand Surgery, The Philadelphia Hand Centers, Thomas Jefferson University, Philadelphia, PA

INTRODUCTION: Arthroscopic trapeziectomy with suture button suspensioplasty (ATBS) is a novel, minimally invasive procedure used to treat symptomatic thumb carpo-metacarpal (CMC) arthritis at all disease stages. The aims of this surgery are to enable a quick return to function and prevent thumb metacarpal subsidence over time. This study investigates the safety and efficacy of this technique.

MATERIALS & METHODS: All charts of patients consecutively treated with partial or complete ATBS at one surgical center, from January 2010 to December 2012, were retrospectively reviewed. One senior hand surgeon performed all cases. Thumb mobilization was allowed 10 days post-operatively. Patient demographics, Eaton-Lambert disease stage, operative time, tourniquet time, preoperative and postoperative pinch strength as well as improvements in patient pain levels and complications were analyzed.

RESULTS: One hundred fifty-seven cases of ATBS were performed in 145 patients: 97 cases involved arthroscopic hemitrapeziectomies and 60 involved complete arthroscopic trapeziectomies. There were 41 males and 104 females with a mean age of 61 (range, 44-92 years). Thirty seven percent of the cases were graded as stage IV, 50% as stage III, and 13% as stage II base of thumb arthritis. The median tourniquet and operative times were 22 minutes (range, 0h11-1h22) and 33 minutes (range 0h20-1h32, respectively, (n=111; no combined procedure). The median follow-up duration was 14 weeks (range, 2 weeks-2.5 years). The mean preoperative key pinch strength of the affected over the unaffected side was 92 % pre-operatively compared to 95% post-operatively, (p=0.77). When both thumbs were operated on, the median of the delay between the 2 procedures was 6 months (range, 0-29 months). Revision arthroplasty was required in 4 out of 157 cases due to the progression of disease with involvement of the triscaphe joint. All other patients experienced improvements in pain and were satisfied with treatment. No postoperative CMC instability was noticed. Two post-operative complications developed (1.3%): 1 patient presented with osteomyelitis of the 1st and 2nd metacarpal bones and the TightropeŽ (TR) was removed 6 weeks post-operatively. In the 2nd case, the button was found to be too prominent over the 2nd metacarpal dorsally and the TR was removed.

CONCLUSIONS: ATBS is a novel minimally invasive procedure used to treat symptomatic thumb CMC arthritis at all disease stages. ATBS is associated with maintenance of pinch strength, joint stability, pain relief, low morbidity and satisfaction. Longer-term follow up will be necessary to evaluate the longevity of the benefits of this procedure.

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