This article is more than 5 years old. Information may no longer be current.
Simple thumb CMC reconstruction technique may yield long-term benefits
Click Here to Manage Email Alerts
SEATTLE — Suture suspension arthroplasty can provide improved function and pain relief in patients who undergo thumb carpometacarpal arthritis reconstruction, according to data presented at the American Society for Surgery of the Hand Annual Meeting, here.
During her presentation, Jeanne L. DelSignore, MD, noted the suture suspension method is beneficial for long-term outcomes, pain relief and satisfaction for patients.
“This method creates a suture suspension sling, similar to a hammock, between the distal most insertion points of the abductor pollicis longus [APL] and flexor carpi radialis [FCR], restoring the first web-space angle, maintaining arthroplasty height and effectively tethering the base of thumb towards the base of index metacarpal. Long-term results of this method reveal similar outcomes to other methods of trapeziectomy with or without reconstruction,” she said.
Positive results from technique
DelSignore and colleagues retrospectively evaluated 117 thumbs in 110 patients who underwent suture suspension arthroplasty for thumb carpometacarpal arthritis reconstruction performed by a single surgeon. Patients had an average follow-up of 89.4 months. They underwent 14 days of thumb immobilization postoperatively followed by splinting for 4 weeks, a rehabilitation protocol and then unrestricted use at 12 weeks postoperatively.
Investigators used radiographic data, strength measurements and QuickDASH values to evaluate the long-term outcomes.
“I utilize a volar incision with complete trapeziectomy. Longitudinal distraction is applied to the thumb as the suture is inserted as distally as possible, through the APL insertion and dorsal capsule and then backhanded through the FCR at its distal-most insertion onto the metacarpal base. I grasp the deep subsheath and capsule to prevent proximal migration of the sling. This is then passed through the arthroplasty space twice to create a four-strand hammock suspension sling,” she said.
Pain relief, patient satisfaction, functional improvement, grip, key and tip pinch strength significantly improved in most patients. Good to excellent patient satisfaction and function was demonstrated by an average QuickDASH score of 0.3 at final follow-up. One patient (0.8%) required surgical revision. Average radiographic subsidence in the study was 29%.
Reproducible outcomes
“We feel that suture suspension arthroplasty offers a simple, lower morbidity, reliable and cost-effective method with both patient and surgeon benefits,” DelSignore said.
Most patients achieve a faster early stage recovery, less stiffness due to earlier range of motion and release to unrestricted use at 3 months. The surgeon and facility benefits include a shorter operative time and cost-effectiveness with no K-wires, anchors or implants used. She said it is a simple, reproducible technique, which she has shared with multiple colleagues during the past 9 years and they have also observed similar outcomes from the procedures. – by Christian Ingram and Robert Linnehan
- Reference:
- DelSignore JL. Paper #42. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 10-12, 2015; Seattle.
- For more information:
- Jeanne L. DelSignore, MD, can be reached at Hand Surgery Associates, LLP, 360 Linden Oaks, Suite 210, Rochester, NY 14625 USA; email: jdelsignore@handsurgeryassoc.org.
Disclosure: DelSignore reports no relevant financial disclosures.