Purpose
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.
Methods
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.
Results
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.
Conclusions
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
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Article info
Publication history
Published online: September 10, 2022
Accepted:
August 5,
2022
Received:
December 16,
2021
Publication stage
In Press Corrected ProofFootnotes
Drs Hozack, Liss, Fram, Rivlin, Ilyas, and Jones received support from Arthrex Inc. (Naples, FL) regarding the provision of the implants and cadavers arms.
Identification
Copyright
© 2022 by the American Society for Surgery of the Hand. All rights reserved.
