First Ray Stabilization With Mini-Tightrope in the Treatment of Trapeziometacarpal Arthritis

Abstract

Objective: Trapeziometacarpal (TMC) arthritis is the most frequent indication for articular reconstruction in the upper limb. The surgical treatment is an option when conservative treatment fails, and TMC joint ligament reconstruction and tendon interposition arthroplasty has been used due to its predictable pain relief and low morbidity. However, there are complications related to this technique, such as donor site pain and tendon failure. Thus, a technique combining trapeziectomy and first ray stabilization with suture has been increasingly used. In this study, we present our results with trapeziectomy and first ray stabilization with mini-tightrope at a minimum 4-month follow-up. Materials and Methods: Seventeen patients with TMC arthritis were treated surgically with trapeziectomy and first ray stabilization with percutaneous placement of mini-tightrope between 2014 and 2015. Four patients had had previous surgical treatment with Weilby or Burton-Pellegrini techniques that failed and in these patients trapeziectomy had already been done. We selected patients who had not responded to physical therapy and who had no high force demand for daily activities. Patients had a minimum follow-up period of 4 months. In the postoperative period, we collected data related to pain using the visual analogue scale (VAS), joint mobility, grip and pinch strength and we also evaluated patients with the Quick Disability of the Arm, Shoulder and Hand (QuickDASH) score. Patient satisfaction with the procedure was also evaluated. Results: We treated 17 patients, 15 women and 2 men, with a mean age of 57 years. Postoperative mobility was good with total opponens, extension, and flexion of the first finger in all patients and mobility without limitation in their daily activities. The average postoperative grip strength was 20 vs 20.6 on the contralateral side. Pinch strength was also decreased with an average postoperative terminolateral pinch strength of 3.84 vs 4.2 on the contralateral side and terminoterminal pinch strength of 3.11 vs 3.27 on the contralateral side. The majority of patients referred a high level of satisfaction with the procedure at 2 months postoperative, with return to their previous activities. We report necessity of removal of the mini-tightrope in 2 cases, one due to pain related to the metal implant of the mini-tightrope, without pain referred to the TMC joint, and another due to conflict between the base of the first and second metacarpal bones. We report 1 case of failure, which was later, revised with good preliminary results. Conclusions: The surgical treatment for TMC arthritis has many valid options. First ray stabilization with a mini-tightrope appears to achieve good results, with pain relief, high patient satisfaction, and a quicker return to work compared with conventional suspension techniques. Few complications were reported in our sample. It appears to be a valuable solution, in order to maintain good mobility in patients with low strength requirements on their daily lives.