Intraoperative Load Tolerance of the Thumb Carpometacarpal Joint After Resection-Suspension-Interposition Arthroplasty

J Hand Surg Glob Online. 2021 Nov 22;4(1):40-44. doi: 10.1016/j.jhsg.2021.10.005. eCollection 2022 Jan.

Abstract

Purpose: The objective was to measure the intraoperative load tolerance of the thumb carpometacarpal (CMC) joint after trapeziectomy, tendon suspension, and interposition.

Methods: In this single-center prospective study, preoperative pinch grip, thumb mobility, and hypermobility of the thumb CMC joint were determined by 2 hand surgeons. Patients completed the brief Michigan Hand Outcomes Questionnaire. During surgery and upon removal of the trapezium, the surgeon subjectively rated the degree of thumb CMC load tolerance as "stable," "medium stable," or "unstable." A measurement system with an integrated force sensor was used to measure intraoperative thumb CMC load tolerance. The thumb ray was displaced manually by 10 mm toward the scaphoid, and the counteracting force was measured over the entire displacement. The objective load tolerance was determined as the maximal measured force after trapezium resection, tendon suspension, and interposition. Analysis of variance was used to test for the differences in load tolerance between the surgical steps. Spearman's coefficient was used to find correlations between load tolerance and clinical or patient-reported variables.

Results: Twenty-nine patients with a mean age of 70 years (SD, 8.1 years) were available for analysis. The measured intraoperative load tolerance after trapeziectomy was 15.5 N (SD, 5.4 N) and significantly increased to 18.7 N (SD, 5.5 N) after suspension. Load tolerance only slightly increased after tendon interposition, increasing the force to 20.3 N (SD, 6.7 N). Neither the surgeon's subjective stability rating nor the clinical or patient-reported variables correlated with the measured load tolerance after trapeziectomy.

Conclusions: Our results show that tendon suspension leads to the highest increase in thumb CMC load tolerance during resection-suspension-interposition arthroplasty.

Clinical relevance: Tendon suspension appears to be the most important step in stabilizing the metacarpal base after trapeziectomy, whereas tendon interposition does not seem to have a relevant additional effect regarding load tolerance, at least immediately after surgery.

Keywords: Biomechanics; Joint stability; Ligament reconstruction with tendon interposition; Surgery; Trapeziometacarpal joint.