One-Year Outcomes of Ligament Reconstruction Tendon Interposition versus Suture Tape Suspensionplasty for Thumb Carpometacarpal Joint Arthritis - Article Summary

Summary Author: Abel Ruíz Díaz

Brief Summary:

Degenerative joint disease (DJD) is a common condition that affects nearly everyone at some point in life. Driven by progressive “wear and tear” of articular cartilage, there is still no reliable method for regenerating lost cartilage. Despite this limitation, orthopedic surgery continues to explore innovative ways to improve quality of life for patients with arthritis. The thumb carpometacarpal (CMC) joint is one of the most frequently affected sites in DJD. It’s estimated that the thumb CMC joint experiences forces up to 12 times greater than those generated at the tip of the thumb during pinching, placing it under substantial mechanical stress. To relieve pain and preserve function in advanced cases, hand surgeons often perform a trapeziectomy (removal of the trapezium bone), eliminating the bone-on-bone component of DJD. This is followed by mechanical suspension of the first metacarpal to prevent subsidence. Several suspension techniques exist, but the two most widely used are:

1.     Ligament Reconstruction and Tendon Interposition (LRTI) – where the flexor carpi radialis (FCR) tendon is harvested and anchored to the base of the first metacarpal (Fig. 1)

2.     Suture Tape Suspensionplasty (STS) – a newer technique that uses suture tape to suspend the metacarpal, anchored to the second metacarpal base (Fig. 2)

This prospective randomized pilot study compares postoperative outcomes in patients undergoing LRTI versus STS for thumb CMC DJD.

Study Design: This single-institution randomized controlled trial included 31 patients (32 thumbs) with advanced thumb CMC arthritis who had failed non-operative treatment. Patients were randomly assigned to undergo either LRTI or STS, with proper randomization confirmed. Postoperative follow-up visits occurred at 2 weeks, 4 weeks, 3 months, and 1 year. Primary outcomes included the Visual Analog Scale (VAS) for pain and PROMIS Upper Extremity (UE) scores for subjective measures of pain and function. Secondary outcomes included objective clinical data such as grip & pinch strength, thumb range of motion, time to return to work or activities, and complications requiring revision.

Findings:

Primary outcomes: No significant differences were observed between groups in VAS pain scores or PROMIS UE scores at any time point. Both groups showed similar clinical improvement by 3 months post-op.

Secondary outcomes: Pinch strength was equal between groups at all time points. Both groups experienced improved grip strength compared to preoperative measurements. Patients in the LRTI group returned to work and activities sooner than those in the STS group. The STS group experienced more complications, including symptomatic subsidence and hardware irritation, some of which required surgery.

Limitations:

• Small sample size: With only 32 thumbs included, this pilot study lacks the statistical power to draw definitive conclusions.

• Single-center design: Limited generalizability to other institutions and surgical practices.

• Short-term follow-up: While the 1-year outcomes are helpful, longer follow-up is needed to assess durability and late complications.

• Surgeon experience bias: LRTI is a more established technique, and the learning curve or preferences could have influenced the outcomes.

Conclusions:

Both LRTI and STS resulted in significant improvements in pain and function after thumb CMC arthroplasty. However, patients who underwent LRTI returned to activities sooner and experienced fewer postoperative complications, suggesting that LRTI remains a more reliable and durable technique. STS may still hold promise but may be more dependent on surgical experience and patient selection.

Main Takeaway

While both LRTI and STS offered equal improvement in pain and thumb function, LRTI remains the most reliable and widely used CMC arthroplasty technique, offering quicker return to activities and fewer complications compared to the STS technique.

References:

Graesser, Emma A, et al. A Prospective Randomized Pilot Study: One-Year Outcomes of Ligament Reconstruction Tendon Interposition Versus Suture Tape Suspensionplasty for Thumb Carpometacarpal Joint Arthritis. The Journal of Hand Surgery, 2024. https://doi.org/10.1016/j.jhsa.2024.02.007.