Suture Suspensionplasty Compared With Ligament Reconstruction and Tendon Interposition for Surgical Treatment of Thumb Carpometacarpal Arthritis

Purpose: Thumb carpometacarpal (CMC) arthritis is the most common arthritis of the hand, with most studies demonstrating little difference in outcomes between various surgical treatment techniques. However, trapeziectomy, followed by ligament reconstruction and tendon interposition (LRTI), remains the technique of choice among hand surgeons in the United States. In 2009, suture suspensionplasty (SS) was first described as a less invasive alternative to LRTI. The purpose of this study was to compare surgical details as well as patient-reported and radiographic outcomes between SS and LRTI for thumb CMC arthroplasty.

Methods: Following Institutional Review Board approval, 111 extremities were retrospectively identified in 104 patients who underwent carpometacarpal arthroplasty. Two age-matched cohorts were developed for patients having undergone LRTI (n = 58) or SS (n = 53) by one of three fellowship-trained hand surgeons. Tourniquet times were compared, and outcome measures included first metacarpal scaphoid space (FMSS) measured on 2-week postoperative radiographs, as well as Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score and pain score on a 10-point visual analog scale (VAS) from the preoperative visit as well as at 2 weeks, 6 weeks, and 3 months following surgery.

Results: There were no demographic differences between the two cohorts. There was no statistical difference between cohorts in VAS scores at any point in time. The SS cohort reported better QuickDASH scores at the 6-week postoperative visit; otherwise, QuickDASH scores did not differ between cohorts. The SS technique had shorter tourniquet times, and patients had less radiographic subsidence as evidenced by larger postoperative FMSS.

Conclusions: The SS arthroplasty technique demonstrated comparable early clinical results to LRTI. Furthermore, SS arthroplasty, which alleviates the need for tendon transfers and additional incisions with LRTI, had shorter tourniquet time, with less subsidence of the first metacarpal in the first 2 weeks.

Type of study/level of evidence: Therapeutic IV.