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First CMC Arthritis - A Novel Staging System and Radiographic Analysis of Suture Button Suspension
Ajul Shah, MD1; Sarah Rizzo, BS1; Anup Patel, MD, MBA1; J. Grant Thomson, MD1; John Safanda, MD2
1Section of Plastic & Reconstructive Surgery, Yale University School of Medicine, New Haven, CT; 2Foundation Hospital, Kaiser Permanente, San Rafael, CA

Introduction: There are numerous approaches for the surgical treatment of thumb CMC joint arthritis. A newer method to reconstruct the beak ligament is suture button suspensionplasty. In this study, we perform a radiographic analysis to determine whether the thumb metacarpal remains suspended over time after suture button suspension. In doing so, we present a novel staging system for thumb CMC arthritis, and subsequently evaluate the proposed benefits of this procedure.

Methods: A retrospective chart review was performed. Pre-operative, 6-week post-operative, and 12 week post-operative x-rays were obtained. Patients were only included if 12 week post-operative x-rays were available. Radiographic analysis included pre-operative Eaton Stage, a novel staging system for CMC arthritis, maximum thumb metacarpal abduction angle, the angle of suspension, and the ratio of suture button height to the height of the index metacarpal. Pre-operative and post-operative results were compared, and statistical analyses were performed.

The novel staging system is shown, and will be described:

Results: 10 patients underwent suspension, and 64 patients returned for 12-week post-operative x-rays. All patients underwent trapeziectomy. The average pre-operative Eaton Stage was 2.98. The novel stage improved from pre-operative to 6-weeks post-operative (0.38 and 0.20 respectively, p = 0.07), and worsened at the 12-week post-operative time point (0.38 and 0.40, p = 0.20). The novel stage was significantly different from 6 to 12 weeks post-operative (p = 0.008). The abduction angle increased from pre-operative to 6-weeks post-operative (20.7 to 34.2 degrees, p = 0.000000000005) and 12-weeks post-operative (20.7 to 33.0 degrees, p = 0.00000000001). The angle of suspension (146 and 149 degrees respectively, p = 0.08) and the ratio of the button height to the height of the second metacarpal (0.35 to 0.36, p = 0.33) did not significantly change between 6 and 12 weeks post-operative.

Conclusion: In this study, we present a radiographic analysis of suture button suspensionplasty. We present a novel staging system that is consistent irrespective of osteoarthritic changes or adduction contractures. We demonstrate that over a short period of time post-operatively, the thumb metacarpal subsides proximally. However, the procedure improves range of motion, as indicated by the increase in maximum abduction angle. These findings, in conjunction with future studies, will allow for further elucidation of the utility of suture button suspension.

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