Systematic Comparison of Ligament Reconstruction with Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis
Shari R Liberman, MD, Austin Edward Wininger, MD, Alex Han, MD, Erin I Orozco, BS and Matthew B Burn, MD, Houston Methodist Hospital, Houston, TX
Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The primary purpose of this systematic review was to compare the subjective improvement in patient reported outcomes in regard to disability for patients undergoing LRTI and SBS for trapeziometacarpal osteoarthritis. A secondary purpose was to compare the subjective improvement, objective outcome scores, and complication rates following both procedures. The authors hypothesize that both interventions will result in similar functional outcomes, grip strength, pinch strength, and complication rates.
We performed a systematic review using PubMed, Scopus, and Embase to compare the clinical outcomes of LRTI and SBS. LRTI was defined by harvesting a strip of the flexor carpi radialis (FCR) tendon, re-routing this graft through a drill hole in the base of the first metacarpal, and interposing the remaining FCR tendon in the void created after trapeziectomy. SBS was defined as any technique involving either a partial or complete trapeziectomy (open or arthroscopic) while utilizing at least one endobutton for suspension without the use of a tendon graft. Inclusion criteria were level I-IV evidence articles reporting post-operative Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH scores. From each article, details regarding the participants, intervention, and outcomes were extracted. Study methodological quality, risk of bias, and recommendation strength were assessed.
This systematic review included 31 studies with 1,289 thumbs undergoing LRTI (25 studies) and 113 thumbs undergoing SBS (6 studies). Both procedures demonstrated similar improvement in DASH and/or QuickDASH scores. There were 19 LRTI studies that reported both preoperative and postoperative DASH or QuickDASH scores, 17 of which demonstrated improvements that exceeded the minimal clinically important difference (MCID). There were 5 SBS studies that reported both preoperative and postoperative DASH or QuickDASH scores, 4 of which demonstrated improvements that exceeded the MCID. In contrast, key pinch and grip strength were inconsistently reported across both procedures, but both procedures generally demonstrated improved strength. Complication rate was similar between the two procedures; LRTI 12% and SBS 13%.
Although both LRTI and SBS seem to provide improved short-term patient-reported functional improvement and objective strength, there was significant heterogeneity within the included studies and those studies discussing SBS were of lower quality evidence than those of LRTI. Thus, to truly delineate whether a difference exists between these two techniques for the treatment of trapeziometacarpal osteoarthritis, larger prospectively-designed studies of high-quality evidence are necessary.
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