Tendon suspension may lead to highest increase in thumb carpometacarpal load tolerance
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Tendon suspension led to the highest increase in thumb carpometacarpal load tolerance during resection-suspension-interposition arthroplasty in patients with thumb carpometacarpal osteoarthritis, according to published results.
Researchers preoperatively determined pinch grip, thumb mobility and hypermobility of the thumb carpometacarpal joint and used the brief Michigan Hand Outcomes Questionnaire to collect patient-reported hand function among 29 patients with primary thumb carpometacarpal OA undergoing trapeziectomy with suspension and tendon interposition arthroplasty.
Two surgeons subjectively rated the degree of thumb carpometacarpal load tolerance as “stable,” “medium stable” or “unstable” during surgery and upon removal of the trapezium. After manual displacement of the thumb ray by 10 mm toward the scaphoid, the surgeons measured the counteracting force over the entire displacement. Researchers used a measurement system with an integrated force sensor to measure intraoperative thumb carpometacarpal load tolerance. Objective load tolerance was determined as the maximal measured force after trapezium resection, tendon suspension and interposition.
Researchers used analysis of variance to test for the differences in load tolerance between the surgical steps and used Spearman’s coefficient to find correlations between load tolerance and clinical or patient-reported variables.
Results showed 13 thumbs were considered stable, seven medium stable and nine unstable after trapeziectomy alone. Researchers found a significant increase in intraoperative load tolerance from 15.5 N after trapeziectomy to 18.7 N after suspension. However, load tolerance only slightly increased after tendon interposition to 20.3 N, according to results. Researchers noted no correlation between either the surgeon’s subjective stability rating or the clinical or patient-reported variables with the measured load tolerance after trapeziectomy. All but one thumb could be displaced 10 mm after trapezium excision and suspension, according to researchers.
Perspective
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In this paper, the authors studied the load tolerance of the thumb carpometacarpal joint following trapeziectomy, tendon suspension and interposition; in other words, their aim was to measure how strong the thumb metacarpal resists passive proximal displacement in three different common treatment scenarios for thumb carpometacarpal OA. They state, even in the first sentence of their paper, what is universally believed regarding the outcomes of surgical treatment for thumb carpometacarpal OA: “There is still no surgical treatment that is known to be superior.” This is one of those conditions for which there exist many different surgical treatment options and all seem to be effective. Therefore, what would the authors choose as their treatment of choice for this condition? Would they perform a tendon suspension rather than a simple trapeziectomy because their study showed a higher load tolerance with the former, even though the literature shows no difference clinically? I believe that as surgeons, what we encounter in our personal experience dictates most strongly how we choose to treat our patients. Due to some early failures seen with trapeziectomy alone, my current treatment of choice is coincidentally supported by this study: trapeziectomy with partial flexor carpi radialis tendon suspension, without interposition.
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