Scientific Article|Articles in Press

Optimal Position of the Bone Anchor for the Internal Brace Suspensionplasty Technique for Thumb Basal Joint Arthroplasty

Published:September 10, 2022DOI:


      Ligament reconstruction and tendon interposition is a common technique for thumb basal joint arthroplasty. Recently, a variation of this technique, a suture suspensionplasty, has been introduced. The goal of our study was to assess the optimal position of the bone anchor in the thumb metacarpal. We hypothesized that an anchor placed in the radial aspect of the thumb metacarpal base would provide improved stability and resist subsidence more effectively than an ulnar-based thumb anchor.


      Eight fresh-frozen cadaver arms were imaged fluoroscopically in anteroposterior and lateral views centered over the thumb carpometacarpal joint before and after trapeziectomy and after the placement of radial-based and ulnar-based bone anchors. The intermetacarpal angle between the thumb and index metacarpals was measured on all images after the application of a standard force. Radial abduction, opposition, subsidence, palmar abduction, and adduction were measured. Subsidence was calculated as the percentage loss of the trapezial space.


      Both radially and ulnarly placed internal brace constructs allowed more radial abduction, opposition, and palmar abduction than the pretrapeziectomy constructs. They both also reduced subsidence by approximately 20% to 29% compared with the posttrapeziectomy constructs. Comparing radial to ulnar constructs, motion and subsidence were similar.


      There was immediate stability of the thumb with respect to axial load and subsidence after anchor placement, and this was independent of the anchor position. The position of the bone anchor in the thumb metacarpal base did not affect the range of motion. Although the device can limit subsidence, it does not appear to restrict any range of motion of the thumb, irrespective of anchor position.

      Clinical relevance

      This cadaver study can help hand surgeons understand the effect of positioning of bone anchors when performing a specific suture suspensionplasty technique.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Van Heest A.E.
        • Kallemeier P.
        Thumb carpal metacarpal arthritis.
        J Am Acad Orthop Surg. 2008; 16: 140-151
        • Burton R.I.
        • Pellegrini V.D.
        Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty.
        J Hand Surg Am. 1986; 11: 324-332
        • Pellegrini V.D.
        • Burton R.I.
        Surgical management of basal joint arthritis of the thumb. Part I. Long-term results of silicone implant arthroplasty.
        J Hand Surg Am. 1986; 11: 309-324
        • Yao J.
        • Park M.J.
        Early treatment of degenerative arthritis of the thumb carpometacarpal joint.
        Hand Clin. 2008; 24 (v-vi): 251-261
        • Higgenbotham C.
        • Boyd A.
        • Busch M.
        • Heaton D.
        • Trumble T.
        Optimal management of thumb basal joint arthritis: challenges and solutions.
        Orthop Res Rev. 2017; 9: 93-99
        • Moran S.L.
        • Berger R.A.
        Biomechanics and hand trauma: what you need.
        Hand Clin. 2003; 19: 17-31
        • Cooney W.P.
        • Chao E.Y.
        Biomechanical analysis of static forces in the thumb during hand function.
        J Bone Joint Surg Am. 1977; 59: 27-36
        • Berger A.J.
        • Meals R.A.
        Management of osteoarthrosis of the thumb joints.
        J Hand Surg Am. 2015; 40: 843-850
      1. Rabinovich RV, Lee SJ, Aguilar MB, Kim A. Management of CMC joint arthritis with an internal brace and tendon interposition: a prospective case series. Paper presented at: 74th Annual Meeting of the American Society for Surgery of the Hand; September 5–7, 2019; Las Vegas, NV.

      2. Lee SJ, Porter D, Coyle R, Kremenic I. Trapeziectomy internal brace suspensionplasty versus ligament reconstruction tendon interposition for thumb carpometacarpal arthritis: a biomechanical study. Paper presented at: 73rd Annual Meeting of the American Society for Surgery of the Hand; September 13–15, 2018; Boston, MA.

      3. Doering TA, Larsen C; Greenberg A, Tuckman D. Prospective analysis of knotless suture anchor suspensionplasty for treatment of basal joint arthritis. Paper presented at: 74th Annual Meeting of the American Society for Surgery of the Hand; September 5–7, 2019; Las Vegas, NV.

      4. Kawahara S, Usami S, Shimizu D, Inami K. Suture Only Knotless Suspensionplasty for Thumb Carpometacarpal Arthritis: A Case Series. Paper presented at: Annual Meeting of the American Association for Hand Surgery; January 8–11, 2020; Ft. Lauderdale, FL.

        • Hozack B.A.
        • Fram B.
        • Ilyas A.M.
        • Rivlin M.
        • Liss F.E.
        • Jones C.M.
        Optimal position of the suture button suspensionplasty (TightRope) for thumb basal joint arthritis.
        Hand (N Y). 2022; 17: 79-84
        • Swanson A.B.
        • deGoot Swanson G.
        • Watermeier J.J.
        Trapezium implant arthroplasty: long term evaluation of 150 cases.
        J Hand Surg Am. 1981; 6: 125-141
        • Athwal G.S.
        • Chenkin J.
        • King G.J.
        • Pichora D.R.
        Early failures with a spheric interposition arthroplasty of the thumb basal joint.
        J Hand Surg Am. 2004; 29: 1080-1084
        • Badia A.
        • Sambandam S.N.
        Total joint arthroplasty in the treatment of advanced stages of thumb carpometacarpal joint osteoarthritis.
        J Hand Surg Am. 2006; 31: 1605-1614
        • De Smet L.
        • Sioen W.
        • Spaepen D.
        • Van Ransbeeck H.
        Total joint arthroplasty for osteoarthritis of the thumb basal joint.
        Acta Orthop Belg. 2004; 70: 19-24
        • Boeckstyns M.E.
        • Sinding A.
        • Elholm K.T.
        • Rechnagel K.
        Replacement of the trapeziometacarpal joint with a cemented (Caffiniére) prosthesis.
        J Hand Surg Am. 1989; 14A: 83-89
        • Ferrari B.
        • Steffee A.D.
        Trapeziometacarpal total joint replacement using the Steffee prosthesis.
        J Bone Joint Surg Am. 1986; 68A: 1177-1184
        • Martinez de Aragon J.S.
        • Moran S.L.
        • Rizzo M.
        • Reggin K.B.
        • Beckenbaugh R.D.
        Early outcomes of pyrolytic carbon hemiarthroplasty for the treatment of trapezial-metacarpal arthritis.
        J Hand Surg Am. 2009; 34: 205-212
        • Khoo C.T.
        Silicone synovitis. The current role of silicone elastomer implants in joint reconstruction.
        J Hand Surg Br. 1993; 18: 679-686
        • Sondergaard L.
        • Konradsen L.
        • Rechnagel K.
        Long-term follow-up of the cemented Caffiniere prosthesis for trapezio-metacarpal arthroplasty.
        J Hand Surg Br. 1991; 16: 428-430
        • Regnard P.J.
        Electra trapeziometacarpal prosthesis: results of the first 100 cases.
        J Hand Surg Br. 2006; 31: 621-628
        • Cooney W.P.
        • Linscheid R.L.
        • Askew L.J.
        Total arthroplasty of the thumb trapeziometacarpal joint.
        Clin Orthop Relat Res. 1987; 220: 35-45
        • Davis T.R.C.
        • Brady O.
        • Dias J.J.
        Excision of the trapezium for osteoarthritis of the trapeziometacarpal joint: a study of the benefit of ligament reconstruction or tendon interposition.
        J Hand Surg Am. 2004; 29: 1069-1077
        • Cooney W.P.
        • Leddy T.P.
        • Larson D.R.
        Revision of thumb trapeziometacarpal arthroplasty.
        J Hand Surg Am. 2006; 31: 219-227
        • Davis T.R.C.
        • Pace A.
        Trapeziectomy for trapeziometacarpal joint osteoarthritis: is ligament reconstruction and temporary stabilisation of the pseudarthrosis with a Kirschner wire important?.
        J Hand Surg Eur Vol. 2009; 34: 312-321
        • Shonuga O.
        • Nicholson K.
        • Abboudi J.
        • et al.
        Thumb-basal joint arthroplasty outcomes and metacarpal subsidence: a prospective cohort analysis of trapeziectomy with suture button suspensionplasty versus ligament reconstruction with tendon interposition.
        Hand (N Y). 2021; 1558944721994227
        • Kapoutsis D.V.
        • Dardas A.
        • Day C.S.
        Carpometacarpal and scaphotrapeziotrapezoid arthritis: arthroscopy, arthroplasty, and arthrodesis.
        J Hand Surg Am. 2011; 36: 354-366
        • Park M.J.
        • Lichtman G.
        • Christian J.B.
        • et al.
        Surgical treatment of thumb carpometacarpal joint arthritis: a single institution experience from 1995-2005.
        Hand (N Y). 2008; 3: 304-310
        • Gerwin M.
        • Griffith A.
        • Weiland A.J.
        • Hotchkiss R.N.
        • McCormack R.R.
        Ligament reconstruction basal joint arthroplasty without tendon interposition.
        Clin Orthop Relat Res. 1997; 342: 42-45
      5. Kriegs-Au G, Petje G, Fojtl E, Ganger R, Zachs I. Ligament reconstruction with or without tendon interposition to treat primary thumb carpometacarpal osteoarthritis. Surgical technique. J Bone Joint Surg Am. 2005;87(suppl 1)(Pt 1):78–85.

        • Chang E.Y.
        • Chung K.C.
        Outcomes of trapeziectomy with a modified abductor pollicis longus suspension arthroplasty for the treatment of thumb carpometacarpal joint osteoarthritis.
        Plast Reconstr Surg. 2008; 122: 505-515
        • Weilby A.
        Tendon interposition arthroplasty of the first carpo-metacarpal joint.
        J Hand Surg Br. 1988; 13: 421-425
        • Gray K.V.
        • Meals R.A.
        Hematoma and distraction arthroplasty for thumb basal joint osteoarthritis: minimum 6.5-year follow-up evaluation.
        J Hand Surg Am. 2007; 32: 23-29
        • Yao J.
        Suture-button suspensionplasty for the treatment of thumb carpometacarpal joint arthritis.
        Hand Clin. 2012; 28: 579-585
        • De Giacomo A.F.
        • Shin S.S.
        Repair of the thumb ulnar collateral ligament with suture tape augmentation.
        Tech Hand Up Extrem Surg. 2017; 21: 164-166
        • Shin S.S.
        • van Eck C.F.
        • Uquillas C.
        SutureTape augmentation of the thumb ulnar collateral ligament repair: a biomechanical study.
        J Hand Surg Am. 2018; 43 (e1–868.e6): 868
        • Thompson R.G.
        • Dustin J.A.
        • Roper D.K.
        • Kane S.M.
        • Lourie G.M.
        Suture tape augmentation for scapholunate ligament repair: a biomechanical study.
        J Hand Surg Am. 2021; 46: 36-42
        • Garcia-Elias M.
        • Tandioy-Delgado F.A.
        Modified technique for basilar thumb osteoarthritis.
        J Hand Surg Am. 2014; 39: 362-367