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–i: Preparation of meniscus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4551622&req=5

Fig2: a–i: Preparation of meniscus

Mentions: Attention was then shifted to preparation of the meniscal allograft for insertion in to the thumb TM space. The graft tissue was placed in a normal saline bath for 5 min to allow it to thaw. A minimum meniscal graft height of 5 mm was a prerequisite for use. The meniscal horns were removed from the tibia fragment (when present) (Fig. 2a). The allograft was then cut transversely into two equal halves (Fig. 2b). Each fragment was then cut to form two rectangular shaped parts measuring 2 cm in length (Fig. 2c). Each part was then cut in the coronal plane for half of its length to create two 1-cm long flaps or “wings” (Fig. 2d). Three fiberwire sutures were then used to connect the two parts leaving the wider portions of the triangular meniscus facing outward creating a rectangular shape to the graft now in two planes (Fig. 2e). Two small incisions were then made at the base of the two inner flaps to allow them to lay flat as the top of the “T” was created (Fig. 2f).Fig. 2


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

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

a–i: Preparation of meniscus
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: a–i: Preparation of meniscus
Mentions: Attention was then shifted to preparation of the meniscal allograft for insertion in to the thumb TM space. The graft tissue was placed in a normal saline bath for 5 min to allow it to thaw. A minimum meniscal graft height of 5 mm was a prerequisite for use. The meniscal horns were removed from the tibia fragment (when present) (Fig. 2a). The allograft was then cut transversely into two equal halves (Fig. 2b). Each fragment was then cut to form two rectangular shaped parts measuring 2 cm in length (Fig. 2c). Each part was then cut in the coronal plane for half of its length to create two 1-cm long flaps or “wings” (Fig. 2d). Three fiberwire sutures were then used to connect the two parts leaving the wider portions of the triangular meniscus facing outward creating a rectangular shape to the graft now in two planes (Fig. 2e). Two small incisions were then made at the base of the two inner flaps to allow them to lay flat as the top of the “T” was created (Fig. 2f).Fig. 2

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