Limits...
Meniscal allograft arthroplasty for the treatment of trapeziometacarpal arthritis of the thumb.

Shapiro PS, Diao E, Givens LM - Hand (N Y) (2015)

Bottom Line: Several surgical options exist showing favorable results.There was a significant improvement in DASH scores.Trapeziometacarpal subsidence was 5.5 %, and subluxation index measurements decreased 3.9 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, William Beaumont Hospital, 3535W. Thirteen Mile Road Suite #744, Royal Oak, MI 48073 USA ; Oakland University William Beaumont School of Medicine, 2200 N Squirrel Road, Rochester, MI 48309 USA ; Michigan Orthopaedic Institute, 26025 Lahser Road, Second Floor, Southfield, MI 48033 USA.

ABSTRACT

Background: Arthritis at the trapeziometacarpal joint of the thumb is common. Several surgical options exist showing favorable results. We report the outcomes after interposition of allograft knee meniscus for thumb trapeziometacarpal arthritis.

Methods: Twenty-three patients (25 thumbs) had surgery for thumb trapeziometacarpal arthritis using knee meniscal allograft tissue. Eleven thumbs had a minimum follow-up of 24 months, 2 thumbs had a minimum of 12 months, and 12 thumbs had less than 6 months. Disabilities of arm, shoulder, and hand (DASH) questionnaire scores, pain levels, grip strength, pinch strength, range of motion, and radiographic measurements were performed.

Results: Between the preoperative and 24-month follow-up measurements, patient pain levels were reduced. There was a significant improvement in DASH scores. Comparisons between preoperative and postoperative strength measurements showed increase in grip strength and key pinch strength. Trapeziometacarpal subsidence was 5.5 %, and subluxation index measurements decreased 3.9 %. There was no clinical or radiographic evidence of foreign body reaction and no other complications occurred.

Conclusions: The results of meniscal allograft arthroplasty are comparable to other surgical techniques for trapeziometacarpal arthritis with respect to pain, outcomes, strength, oppositional motion, complications, surgical time, cost, and return to work. The results suggest that meniscal allograft arthroplasty is a viable option in the surgical management of stages II and III arthritis of the TM joint. Further follow-up and clinical studies are warranted.

No MeSH data available.


Related in: MedlinePlus

a–e Operative procedure 1
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4551622&req=5

Fig1: a–e Operative procedure 1

Mentions: Anesthesia consisted of a regional block induced prior to surgery along with sedation. A long-acting pain pump was used for all patients in the series, but is no longer currently used as it is felt not to be necessary. A dorsoradial incision was made obliquely over the TM joint (Fig. 1a). The superficial branches of the radial nerve were identified and protected. An interval between the abductor pollicis longus (APL) and extensor pollicis brevis tendons was dissected. The radial artery was identified proximally and protected by mobilizing it dorsally. A longitudinal incision was made through the TM joint capsule ulnar to the APL insertion extending 1.5 cm proximal and distal to the joint to create two periosteal sleeves (Fig. 1b). A small oscillating saw was used to remove 2–3 mm of distal trapezium (Fig. 1c). The dorsal cortex of both the trapezium and the proximal metacarpal were then removed using a small burr or a rongeur (Fig. 1d). Absorbable suture anchors holding 2–0 Fiberwire (Arthrex, Inc., Naples, FL) with two tapered needles at the suture ends were inserted into the trapezium and the metacarpal base (Fig. 1e).Fig. 1


Meniscal allograft arthroplasty for the treatment of trapeziometacarpal arthritis of the thumb.

Shapiro PS, Diao E, Givens LM - Hand (N Y) (2015)

a–e Operative procedure 1
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4551622&req=5

Fig1: a–e Operative procedure 1
Mentions: Anesthesia consisted of a regional block induced prior to surgery along with sedation. A long-acting pain pump was used for all patients in the series, but is no longer currently used as it is felt not to be necessary. A dorsoradial incision was made obliquely over the TM joint (Fig. 1a). The superficial branches of the radial nerve were identified and protected. An interval between the abductor pollicis longus (APL) and extensor pollicis brevis tendons was dissected. The radial artery was identified proximally and protected by mobilizing it dorsally. A longitudinal incision was made through the TM joint capsule ulnar to the APL insertion extending 1.5 cm proximal and distal to the joint to create two periosteal sleeves (Fig. 1b). A small oscillating saw was used to remove 2–3 mm of distal trapezium (Fig. 1c). The dorsal cortex of both the trapezium and the proximal metacarpal were then removed using a small burr or a rongeur (Fig. 1d). Absorbable suture anchors holding 2–0 Fiberwire (Arthrex, Inc., Naples, FL) with two tapered needles at the suture ends were inserted into the trapezium and the metacarpal base (Fig. 1e).Fig. 1

Bottom Line: Several surgical options exist showing favorable results.There was a significant improvement in DASH scores.Trapeziometacarpal subsidence was 5.5 %, and subluxation index measurements decreased 3.9 %.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, William Beaumont Hospital, 3535W. Thirteen Mile Road Suite #744, Royal Oak, MI 48073 USA ; Oakland University William Beaumont School of Medicine, 2200 N Squirrel Road, Rochester, MI 48309 USA ; Michigan Orthopaedic Institute, 26025 Lahser Road, Second Floor, Southfield, MI 48033 USA.

ABSTRACT

Background: Arthritis at the trapeziometacarpal joint of the thumb is common. Several surgical options exist showing favorable results. We report the outcomes after interposition of allograft knee meniscus for thumb trapeziometacarpal arthritis.

Methods: Twenty-three patients (25 thumbs) had surgery for thumb trapeziometacarpal arthritis using knee meniscal allograft tissue. Eleven thumbs had a minimum follow-up of 24 months, 2 thumbs had a minimum of 12 months, and 12 thumbs had less than 6 months. Disabilities of arm, shoulder, and hand (DASH) questionnaire scores, pain levels, grip strength, pinch strength, range of motion, and radiographic measurements were performed.

Results: Between the preoperative and 24-month follow-up measurements, patient pain levels were reduced. There was a significant improvement in DASH scores. Comparisons between preoperative and postoperative strength measurements showed increase in grip strength and key pinch strength. Trapeziometacarpal subsidence was 5.5 %, and subluxation index measurements decreased 3.9 %. There was no clinical or radiographic evidence of foreign body reaction and no other complications occurred.

Conclusions: The results of meniscal allograft arthroplasty are comparable to other surgical techniques for trapeziometacarpal arthritis with respect to pain, outcomes, strength, oppositional motion, complications, surgical time, cost, and return to work. The results suggest that meniscal allograft arthroplasty is a viable option in the surgical management of stages II and III arthritis of the TM joint. Further follow-up and clinical studies are warranted.

No MeSH data available.


Related in: MedlinePlus