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American Association for Hand Surgery

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Thumb Carpometacarpal Arthroscopy: A Systematic Review of these Novel Techniques
Beau M McGinley, BS1, John T Hurt, BS2, Roy Toston, BS3, Alex Dawes, BS1, Michael Gottschalk, MD4 and Eric R. Wagner, MD2, (1)Emory University School of Medicine, Atlanta, GA, (2)Emory University, Atlanta, GA, (3)Emory University School Medicine, Atlanta, GA, (4)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA

INTRODUCTION: First carpometacarpal (CMC) osteoarthritis (trapeziometacarpal osteoarthritis) is a common condition with myriad treatment options. This study aimed to perform a systematic review of the use of arthroscopic techniques for treatment of first CMC arthritis to assess effectiveness of different arthroscopic techniques.
METHODS: A search of PubMed and Embase was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Grip strength, pinch strength, visual analog scale, Disability of Arm Shoulder and Hand (DASH) scale, range of motion (ROM), and complications were recorded. Two subgroup analyses were performed by comparing the outcomes of studies that implemented different surgical techniques: 1) trapeziectomy of any type vs. debridement alone 2) trapeziectomy alone vs. interposition vs. suspension techniques.
RESULTS: Twenty-two studies were included, with 733 operations performed across 708 patients. Preoperative and postoperative scores significantly improved for DASH scores, pain at rest and with activity, with variable improvements in ROM. Complications occurred in 13% of cases in those publications that reported complications, with non-specific pain or irritation being the most common complication (58%). In one subgroup analysis comparing studies that utilized techniques with any type of trapeziectomy to debridement alone, only the trapeziectomy subgroup showed significant improvements in pain. When comparing trapeziectomy alone to interposition and suspension techniques, mean DASH scores and pain levels significantly improved in the interposition and suspension subgroups.
CONCLUSION: In a predominantly female population with Eaton-Littler stage II and III disease, arthroscopic techniques significantly improved pain scores, both resting and active, as well as DASH scores. All the arthroscopic techniques improved both pain and functional outcomes, with more predictable improvements in those who underwent trapeziectomy and either interposition or suspensionplasty. The results of this study can be used for the foundation of future large prospective studies assessing the most effective techniques in the arthroscopic management of CMC arthritis.


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