gms | German Medical Science

Objectives/Interrogation: On review of the current literature,the most common procedure for painful carpometacarpal joint of the thumb (CMC-I)osteoarthritis remains trapeziectomy with or without tendon suspension and interposition. We were encouraged by excellent 2-year results using the mini-TightRope (mTR) to suspend the thumb metacarpal, replacing the need for tendon suspension and interposition. The aim of this prospective study is to report minimum 5 years (to 7 years) results of 67 patients operated from 2010 to 2013 using the mTR alone for suspension following trapeziectomy in advanced CMC-I osteoarthritis

Methods: 67 Patients (72 thumbs) (F:64 M:3), mean age 60 (44-76) years, with painful CMC-I osteoarthritis, treated conservatively longer than 1 year, were studied. The surgical technique included open trapeziectomy with suspension of the thumb metacarpal to the 2nd metacarpal using a mini-TightRope. Patients were immobilised for 10 to 14 days and range of motion exercises started. Pain was recorded on a visual analogue scale (VAS) before surgery and after 6, 12 and 60+ months. Thumb function was also recorded, measuring quick DASH, key pinch grip strength, first webspace angulation and range of motion (Kapandji method). Radiographic measurements included the trapezial space ratio. Any complications were documented

Results and Conclusions: 67 patients (F:64 M:3) (72 thumbs) were reviewed after 5 years, mean follow-up of 6 years. Their mean age was 60 (44-76) years.There was no intraoperative complication nor need for device removal. The average VAS pain improved from 7.66 preop to 0.07 postoperatively. The average quickDASH improved from 60 to 5.5. The first webspace angulation improved from 33.6° to 38.1°. The range of motion improved from average 7.8 (Kapandji score) preop to 9.3 postop. The average key pinch grip of the operated thumb was 3.36 kg preop and improved to 3.74 kg postoperatively, 94% of the nonsurgical side. The trapezial space ratio averaged 0.2 with minimal metacarpal subsidence.

Use of the mTR to suspend the thumb metacarpal following trapeziectomy is a simple procedure allowing for early mobilisation of the thumb postoperatively. It provides significant improvement in pain (VAS) and function (qDASH), improves range of motion, webspace, and pinch strength. There have been no complications related to the mTR. We conclude, based on 5-year results, that using a mini-TightRope is a safe and effective method to suspend the thumb metacarpal after trapeziectomy, without need for immobilisation nor tendon harvest.