Suture Anchor Arthroplasty for Thumb CMC Osteoarthritis

ABSTRACT

Ligament reconstruction tendon interposition arthroplasty for basal joint arthritis of the thumb is a well-proven technique with a history of excellent results. One of the most difficult points of the surgery is creating the transosseous tunnel in the base of the first metacarpal and passage of the flexor carpi radialis tendon through this tunnel. Complications include intra- or postoperative fracture through the bone tunnel, unreliable placement of the tendon anchor site to the first metacarpal using a drill, and difficulty passing the tendon through the tunnel. A new, slightly modified technique is presented for ligament reconstruction tendon interposition arthroplasty using suture anchors that simplifies the operation, eliminates some complications, and saves operative time by eliminating the need for a transosseous tunnel. A follow-up study was performed to determine the clinical outcome of the new technique, termed suture anchor arthroplasty.

Sixteen consecutive patients (18 hands) underwent suture anchor arthroplasty. Each hand was assessed with a standardized physical examination, radiographs, patient satisfaction, grip strength, and key pinch strength preoperatively and at follow-up.

After average 15-month follow-up (range: 5-41 months), all thumbs were stable on examination and experienced pain relief. Fifteen (94%) of 16 patients were satisfied. All patients would have the surgery again if given the choice. Grip strength improved by 66% and key pinch strength increased by 34% compared with preoperative values. Loss of the trapezial space height averaged 35% on radiographs. No suture anchor failures were noted, and no patient required reoperation.

Suture anchor arthroplasty provides excellent clinical results comparable to all past studies of the ligament reconstruction tendon interposition arthroplasty for thumb carpometacarpal osteoarthritis. No transosseous tunnel is needed in the first metacarpal, therefore, dorsal exposure of the first metacarpal is avoided, bone tunnel complications are avoided, and no time is wasted making the tunnel or passing the flexor carpi radialis tendon. Precise anchoring of the flexor carpi radialis tendon to recreate a sling effect in the direction of the palmar oblique (beak) ligament also is made easier with the use of suture anchors. Overall, the use of suture anchors in the first metacarpal simplifies ligament reconstruction tendon interposition arthroplasty, prevents some complications, and saves operative time.