Carpometacarpal Arthroplasty Research Articles

Arthroplastie par prothèse trapézo-métacarpienne Moovis – une étude fonctionnelle rétrospective de 19 cas

Since the first descriptions of thumb carpometacarpal (CMC) joint arthritis treatment, various prosthesis had been described. The use of dual mobility is a concept recently introduced for carpometacarpal arthroplasty and inspired by hip arthroplasty experience. The aim of this study was to report the early functional results of a patient cohort treated with a dual mobility prosthesis (MOOVIS®). Nineteen non-anatomic stem prosthesis were implanted between March 2014 and October 2016 by the same senior surgeon with the same technique for severe trapezio-metacarpal arthritis. Functional results were evaluated thanks to Quick Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH), Michigan Hand Outcomes Questionnaire (MHQ) and a satisfaction questionnaire. Clinical results were appraised by Kapandji score and power handling. The average time of follow-up was 20 months. One complication appeared after surgery–a trapezial fracture. No dislocation was observed at early and middle follow-up. Mean preoperative pain was 8 (DS 2.06) on visual analogic scale versus postoperatively 1 (DS 1.3). Kapandji anteposition score was 10 (DS 0.55) and retroposition 1 (DS 1.3). There was no significate difference between operated hand and contralateral hand concerning grip strength, key pinch, tip pinch with respectively, P = 0.86, P = 0.39, P = 0.85. Mean Quick DASH was 15 (DS 14.8) and MHQ was 53 (DS 39.73). We found significate pain decreasing after surgery, improvement of mobility with a Kapandji score almost normal, and a power grip equal to contralateral side and sometimes better than contralateral arthritic side. DASH score showed a low incapacity level after surgery and MHQ score confirmed encouraging results concerning function, aesthetic, pain and satisfaction. Range of motion and power handling were similar to other studies. No dislocation was observed in the early and middle follow-up. Longer follow-up is needed to conclude than dual-mobility concept have resolved the problem of implant dislocation. Dual mobility arthroplasty for treatment of the thumb CMC joint osteoarthritis had proved, in this short series, to be a satisfactory solution for patients with good functional results and absence of early and middle term dislocations.

Revision of the Failed Thumb Carpometacarpal Arthroplasty.

To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. Therapeutic IV.

Arthrodesis of the trapeziometacarpal joint

Bony fusion of the trapeziometacarpal joint. High demands concerning stability and strength of the thumb in primary or secondary osteoarthritis (e.g., posttraumatic osteoarthritis following injuries to the carpometacarpal joint of the thumb); instability in the absence of osteoarthritis due to malformations, ligamentous laxicity, and joint hypermobility; malformations; improvement of hand function in neurological disorders; salvage procedure after carpometacarpal arthroplasty provided bone stock is sufficient. Osteoarthritis or stiffness of adjacent joints, activities demanding maximal mobility of the thumb, insufficient bone stock. Resection of the articular surfaces of the trapeziometacarpal joint via adorsal approach. After temporary K‑wire transfixation, application of adorsal T‑shaped plate (fixed angled or not), replacement of the K‑wire with alag screw. Immobilization for 8weeks (radial below-elbow cast including the thumb metacarpophalangeal joint); standard radiographs on second postoperative day and after 8weeks; removal of stitches after 2weeks; with bony healing after removal of the cast, guided exercises to increase strength and mobility; full loading for manual tasks after 3months. With regards to strength, stability, and pain reduction, results are rated as good and excellent with ahigh degree of patient satisfaction. Disadvantages are implant-related complications and nonhealing of the fusion in an average of 13% of patients. Nevertheless, the procedure is still indicated in young manual workers who tolerate some limitations of mobility.

Radiographic interpretation of carpometacarpal arthroplasty: correlation between radiographic loosening and clinical outcome.

To assess the radiographic appearance and interpretation of loosening in patients following first carpometacarpal joint pyrohemisphere arthroplasty. A retrospective review over a 6-year period was performed identifying patients with first carpometacarpal pyrohemisphere implants. All postoperative radiographs were reviewed and compared with clinical information. Loosening was defined as greater than 1mm of periprosthetic lucency or increasing lucency on serial studies. Adverse clinical outcome was defined as infection, complex regional pain syndrome, subluxation or an inability to return to activities of daily living. Statistical analysis included Cohen's Kappa coefficient to measure inter-reader agreement for radiographic interpretation and the agreement between radiographic loosening and an undesired or adverse clinical outcome. Thirty-one implants in 26 patients were reviewed. A total of 73 postoperative radiographs were reviewed. The mean age of the study subjects was 58years. The mean radiographic follow-up was 13months (range: 1-56). All arthroplasties were performed for osteoarthritis. Only one repeat surgery was performed. There was good agreement amongst readers with regard to radiographic interpretation, but the strength of agreement between radiographic loosening and adverse clinical outcome was poor. The sensitivity of radiography in predicting an adverse clinical outcome was 63%, specificity 65%, positive predictive value 39%, and negative predictive value 83%. Although radiography may be useful in the correct clinical context, it should not be utilized as the sole predictor of adverse clinical outcomes following carpometacarpal arthroplasty.

The Effect of Metacarpophalangeal Joint Hyperextension on Outcomes in the Surgical Treatment of Carpometacarpal Joint Arthritis.

Purpose In the surgical treatment of thumb carpometacarpal (CMC) joint arthritis, the effect of mild preoperative metacarpophalangeal (MCP) hyperextension on postoperative functional outcomes is unknown. We sought to examine outcomes after surgical treatment of CMC arthritis in patients with and without mild preexisting MCP deformity. Methods A retrospective review was conducted to analyze the functional outcomes of patients treated for CMC arthritis at a single institution from March 1998 to May 2009. All patients were treated with one of two standard CMC arthroplasty procedures-either ligament reconstruction tendon interposition (LRTI) or a Weilby procedure-and none had additional procedures to address MCP hyperextension. Pre- and postoperative assessments included pinch and grip strength, degree of MCP hyperextension, and thumb radial and palmar abduction. A t -test was used to assume unequal variances. Results A total of 203 patients were followed for an average of 27.3 months. Patients were divided into two groups: (1) patients without preoperative MCP hyperextension (167 patients) and (2) patients with mild but untreated preoperative MCP hyperextension (≤ 30 degrees; 36 patients). All patients underwent either a Weilby procedure (118 patients) or an LRTI; 85 patients). The main difference between techniques was the use of the abductor pollicis longus tendon as a post to secure the flexor carpi radialis (Weilby) or the use of a bone tunnel in the first metacarpal (LRTI). Analysis of the preoperative data showed no difference in the baseline parameters among both the groups, with the exception of MCP hyperextension. Postoperatively, neither the type of CMC procedure nor the presence of MCP hyperextension demonstrated any significant differences in key pinch, tip pinch, grip strength, and radial or palmar abduction of the thumb between the groups. Conclusion There were no statistically significant differences in improvement of functional outcomes after surgery when comparing patients without preoperative MCP hyperextension to patients with untreated MCP hyperextension of less than 30 degrees. Level of Evidence Level III, retrospective comparative study.

Correction of a Hyperextension Deformity at the Metacarpophalangeal Joint by Arthroplasty for Osteoarthritis of the Thumb Carpometacarpal Joint Followed by External Fixator: A Case Series

A hyperextension deformity in the advanced stages of carpometacarpal (CMC) arthritis of the thumb could affect the outcomes of thumb CMC joint arthroplasty. We introduce the interesting approach for treating severely collapsed thumb deformities with gradual distraction and coordinated correction of the MCP and CMC joints by means of external fixators. We divided 8 cases into 3 groups according to the angle of passive flexion of the hyperextended MCP joint: group 1, 10-20°, group 2a, 20-40°, and group 2b, >40°, retrospectively. We first performed CMC arthroplasty with trapezium excision. In group 1, we corrected the MCP hyperextension deformity by manual passive flexion and fixed the joint with an extension block Kirshner wire (K-wire) for 2months. However, deformities recurred in 2 of 5 cases after removing the K-wire. These patients received corrective percutaneous osteotomy with external fixators at the metacarpal neck. In groups 2a and 2b, we performed CMC arthroplasty and set external fixators at the same time. All cases in groups 1 and 2a have been without recurrence for more than 2years, while a deformity recurred in group 2b. The results of this small case series encouraged us to propose an interesting approach for collapsed zigzag thumb deformity. Good outcomes with excellent maintenance of active MCP movement and no recurrence are highly anticipated if the hyperextended thumb has no obvious degenerative changes and can be corrected by <40° of passive flexion. Our results also indicate a risk of recurrence associated with extension block by K-wire.

Midcarpal and STT Arthritis in Patients With CMC Arthritis

Introduction: Carpometacarpal (CMC) arthroplasty provides well-documented pain relief with preservation of thenar function. Nevertheless, a segment of the population undergoing this procedure will continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a major contributor to persistent pain after CMC arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. The goal of this study is to establish the radiographic prevalence of midcarpal arthritis in patients with CMC arthritis and/or STT (scaphotrapezotrapezoid) arthritis. Methods: Patients with basal joint arthritis were identified from a billing search using International Statistical Classification of Diseases and Related Health Problems (ICD)-9 code 716.94. Hand radiographs were retrospectively reviewed and graded using the Eaton classification and Sodha classification for CMC arthritis. STT arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis. Results: In all, 896 x-rays were reviewed. The overall prevalence of STT arthritis in this population was 64%. The overall prevalence of midcarpal arthritis in this population was 23.5%. The prevalence of midcarpal arthritis in patients with radiologic evidence of CMC arthritis was 25.4%. The prevalence of severe midcarpal arthritis was 7%. Conclusions: The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24%. The presence of 2 locations of arthritis may explain persistent hand and wrist pain in this population despite CMC arthroplasty. Clinically, this data will allow hand surgeons to better educate patients with basal joint and midcarpal arthritis regarding the possibility of incomplete pain relief following CMC arthroplasty.

Midcarpal and Scaphotrapeziotrapezoid Arthritis in Patients with Carpometacarpal Arthritis.

Carpometacarpal arthroplasty provides well-documented pain relief with preservation of thenar function in basal joint arthritis treatment. Nevertheless, some patients continue to have pain following surgery. The authors hypothesize that unrecognized midcarpal (capitolunate) arthritis is a contributor to persistent pain after carpometacarpal arthroplasty. The prevalence of midcarpal arthritis in patients with basal joint arthritis is unknown. This article establishes the radiographic prevalence of midcarpal arthritis in patients with carpometacarpal arthritis. Patients with basal joint arthritis were identified from a search using International Classification of Diseases, Ninth Revision code 716.94. Hand radiographs were reviewed and graded using the Eaton classification and Sodha classification for carpometacarpal arthritis. Scaphotrapeziotrapezoid arthritis and midcarpal arthritis were graded using the Sodha classification for arthritis as follows: grade 1, no or nearly no arthrosis; grade 2, definite arthrosis but not severe; and grade 3, severe arthrosis. Eight hundred ninety-six radiographs were reviewed. The prevalence of scaphotrapeziotrapezoid arthritis in this population was 64 percent. The prevalence of midcarpal arthritis in this population was 23.5 percent. The prevalence of midcarpal arthritis in patients with radiologic evidence of carpometacarpal arthritis was 25.4 percent. The prevalence of severe midcarpal arthritis was 7 percent. The prevalence of midcarpal arthritis in patients with basal joint arthritis is 24 percent. The presence of two locations of arthritis may explain persistent hand and wrist pain in this population despite carpometacarpal arthroplasty. Clinically, these data will allow hand surgeons to better educate patients with basal joint arthritis regarding the possibility of incomplete pain relief following carpometacarpal arthroplasty.

The “Pillow” Technique for Thumb Carpometacarpal Joint Arthritis: Cohort Study With 10- to 15-Year Follow-Up

Arthritis of the carpometacarpal joint of the thumb is common, and there are many studies regarding its treatment. We investigated the long-term outcome of interposition arthroplasty with a fascia lata allograft (pillow technique), without ligament reconstruction, to treat thumb carpometacarpal arthritis. The technique consisted of complete trapeziectomy, use of alloplastic tensor fascia lata, and K-wire immobilization for 5 weeks. The outcomes of 31 thumbs in 24 female patients were measured at a mean follow-up of 12.5 years (range, 10-15 years). Grip strength, key pinch, pulp-to-pulp pinch, tripod pinch, and range of motion were all improved. The Disabilities of the Arm, Shoulder, and Hand median score, which was only measured postoperatively, was an average of 5 (range, 0-52.6). No extrusion of the graft material was noted, and no revisions were performed. Our results indicate that a fascia lata allograft can be used as an interposition material in thumb carpometacarpal arthroplasty. This technique provides pain relief and satisfactory function at an average of 12.5 years after surgery. Therapeutic IV.

Increased Complications in Trapeziectomy With Ligament Reconstruction and Tendon Interposition Compared With Trapeziectomy Alone.

In the treatment of basal joint arthritis of the thumb, recent studies suggest equivalent outcomes with regard to long-term pain, mobility, and strength, in patients undergoing either trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). The goal of this study was to investigate risk factors for complications in carpometacarpal (CMC) arthroplasty. We conducted a retrospective chart review of 5 surgeons at a single institution performing CMC arthroplasties from November 2006 to November 2012. A total of 200 thumbs in 179 patients underwent simple trapeziectomy with or without LRTI and with or without Kirschner wire stabilization, or a Weilby procedure. The average follow-up was 11.6 months (range = 1-69 months). Data collection included sex, age, history of smoking or diabetes, and any other surgeries performed on the hand at the time of arthroplasty. Furthermore, we collected outcomes involving any adverse events, paying attention to those necessitating reoperation, antibiotics, or those who developed complex regional pain syndrome. Seventy hands had a postoperative complication. Ten of these complications were considered major, defined as requiring antibiotics, reoperation, or other aggressive interventions. On multivariate analysis, risk of total complications was significantly greater only in patients undergoing either trapeziectomy with LRTI or Weilby procedure in comparison with trapeziectomy with K-wire stabilization (odds ratio = 4.30 and 6.73, respectively). Patients undergoing trapeziectomy with LRTI or Weilby had a greater incidence of reported complications when compared with trapeziectomy alone. These results suggest an advantage of simple trapeziectomy; however, further study is warranted.

Absence of Flexor Carpi Radialis during an Elective Carpometacarpal Arthroplasty of the Thumb: A Rare Anatomical Variation.

Purpose. We present an extremely rare anatomical variation of unilateral flexor carpi radialis (FCR) absence. This rare anatomical variation posed a clinical dilemma to us and we highlight the importance of the surgeon being aware of this anatomical variation of an important structure both as a reconstruction tool and as an anatomical landmark. Methods. This anatomical variation of the unilaterally absent FCR was found upon dissection during a carpometacarpal arthroplasty of the thumb. Results. Upon the discovery of an absent FCR tendon, we proceeded with a simple trapeziectomy. Conclusions. We present an extremely rare anatomical variation of unilateral FCR absence. This rare anatomical variation may pose clinical dilemmas to the operating surgeon who aims to utilise the FCR either for tendon transfer, for tendon graft, or, as seen in our case, in the reconstruction of a carpometacarpal excision at the thumb. We highlight this diagnosis of suspicion, which may influence the clinical procedure.

New technique: AlloDerm® interposition arthroplasty of thumb carpo-metacarpal joint

Excision arthroplasty is an alternative procedure for degenerative arthritis of the trapezium carpal bone that has failed non-surgical treatment. Autologous or heterologous interposition materials are used following excision of the trapezium, but may not prevent first metacarpal-scaphoid joint collapse or subsidence. AlloDerm® is a cadaver-harvested, immunologically inert dermal collagen graft. This report documents the uncomplicated use of AlloDerm® in 13 thumbs of 9 patients who had first carpometacarpal (CMC) joint excision interposition arthroplasty for degenerative arthritis. Joints functioned well after arthroplasty with AlloDerm®. These clinical results compare favorably to results in 6 Silicon implant CMC arthroplasty patients, and 3 autologous dermal graft CMC arthroplasty patients. Future clinical research, on joint stability, the durability of this collagen graft, newer dermal collagen substrates, and prevention of metacarpal subsidence, will determine the ultimate role of AlloDerm® in interposition arthroplasty.

Thumb carpometacarpal arthritis.

Osteoarthritis of the thumb carpometacarpal joint has a reported radiographic prevalence of 7 percent in men and 15 percent in women. Many patients remain minimally symptomatic; however, a subset of patients develop debilitating pain, weakness, and instability that severely limit hand function. Treatment options have focused on removal of the diseased trapezium and stabilization of the metacarpal base. Newer options, including carpometacarpal arthroplasty, may have a role in some patients for improving function. This article explores the anatomy and biomechanics of carpometacarpal arthritis and its present surgical treatment options.

First and Second Metacarpal Bone Fusion for First Carpometacarpal Joint Arthritis in Rheumatoid Arthritis: A Case Report

A case of rheumatoid thumb carpometacarpal (CMC) arthritis with advanced osteolysis is reported. Although CMC joint arthrodesis was performed, bone union was not achieved, and pain and instability persisted. Therefore, first and second metacarpal bone fusion was performed with satisfactory results. While CMC joint arthrodesis or arthroplasty is typically performed, first and second metacarpal bone fusion appears to be a useful treatment option when there is marked osteolysis.

Little Finger Carpometacarpal Arthroplasty Technique and Result in 3 Cases

To present our surgical technique and results for the treatment of posttraumatic arthritis of the little finger carpometacarpal (CMC) joint. We performed a retrospective review of 3 patients who underwent our surgical technique. All patients had previously sustained intra-articular fractures of the base of the little finger metacarpal and presented with painful posttraumatic arthritis of the fifth metacarpal-hamate joint. Patients were treated with little finger CMC arthroplasty and extensor carpi ulnaris suspensionplasty. We observed the 3 patients in the office over a mean of 21 months and by telephone for a mean for 51 months postoperatively. They had improvements in wrist motion and grip strength. Finger motion remained stable. Pain and tenderness at the little finger CMC joint were eliminated. Our technique provided satisfactory pain relief and motion preservation for posttraumatic arthritis of the little finger CMC joint. Therapeutic IV.

First carpometacarpal arthroplasty with ligamentous reconstruction: a long-term follow-up.

The purpose of the present study is to evaluate a single surgeon's short, intermediate, and long-term clinical, functional, and radiographic outcomes with a trapeziectomy with flexor carpi radialis (FCR) suspension arthroplasty without tendon interposition (LRSA). Twenty-one patients underwent 26 FCR suspension arthroplasties without tendon interposition by a single senior surgeon. All patients had Eaton stage III and IV carpometacarpal (CMC) osteoarthritis. The Patient-Rated Wrist and Hand Evaluation (PRWHE) and Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) were used to evaluate functional outcomes. A comprehensive strength and range of motion evaluation was performed to evaluate clinical outcomes. Plain radiographs at rest and with maximal pinch were performed to evaluate for arthroplasty space subsidence. The LRSA exhibited consistent clinical and functional outcomes throughout postoperative follow-up. As the average patient age and time from surgery increased, range of motion (ROM) and PRWHE scores stayed relatively constant, while lateral tip and tip pinch strength deteriorated with time. The LRSA prevented the proximal migration of the first metacarpal in all but one patient. No patients required revision arthroplasty following LRSA. This study demonstrates the consistent short, intermediate, and long-term clinical, functional, and radiographic outcomes following a trapeziectomy with FCR suspension arthroplasty.

Thumb basal joint: Utilizing new technology for the treatment of a common problem

New technology has the potential to greatly impact the medical field because it may lead to a greater quality of life, decreased pain, or increased function for our patients. This manuscript will discuss the introduction of one such advance in hand surgery and hand therapy. Utilizing the Mini-Tightrope™ (Arthrex, Naples, FL) for suspension of the thumb metacarpal following trapeziectomy is a new technique for treating thumb carpometacarpal (CMC) arthritis. This technique is described as an example of the advantages of considering new techniques and technologies when treating established problems. This article discusses the responsibility of health professionals in considering the adoption of new technologies over current ones in the context of describing a new type of CMC suspensionplasty procedure. Further, a description of the surgical technique, the hand therapy postoperatively, and a case study to demonstrate some of the features of the Tightrope suspensionplasty procedure is presented. In the author's experience, the reduced healing time, reduced weeks of immobility, and fewer therapy visits following the procedure suggest that the Tightrope procedure should be considered as an option for patients needing thumb CMC arthroplasty.

Trapezial Topography in Thumb Carpometacarpal Arthritis

Objective Contradictory reported arthritic patterns of the metacarpal surface of the trapezium include preferential volar wear, radial wear, and dorsal-ulnar sparing. We investigated whether a predominant wear pattern exists in surgical trapeziectomy for advanced thumb carpometacarpal (CMC) arthritis. Methods We examined 36 intact trapezia from 34 thumb CMC arthroplasty patients over an 18-month period. The first metacarpal articular surface revealed three consistent morphology patterns: (1) saddle, (2) dish, and (3) cirque. The saddle represented cartilage loss with preservation of the normal trapezial morphology. The dish shape represented concave curvature, with loss of the normal saddle configuration. The cirque shape represented preferential volar concave wear, disrupting the convex volardorsal arc. Two surgeons classified the randomized specimens twice, blinded to patient identity and each other's categorization. Radiographic Eaton staging was correlated retrospectively for 35 of 36 of the trapezial specimens. Eight specimens were further quantified with micro-computed tomography (micro-CT). Results Thirty-six trapezia were classified as follows: 17 (47%) saddle, 12 (33%) dish, and 7 (19%) cirque. Intra-rater reliability was 0.97 and 0.95; inter-rater reliability in the second round was 0.95. The 36 trapezia represented 27 female (75%) and 9 male (25%) patients; 18 (50%) represented the dominant hand. Age at surgery averaged 64 (33-76). Complete cartilage loss of the entire metacarpal surface was seen in 15 (42%) of all specimens. Osteophyte presence was typically minimal in the saddle group; the dish group had characteristic extensive rimming osteophytes in a 91% female population (11/12), and the cirque group had volar osteophytes. Radiographic severity ranged from Eaton stage II to IV; less severe radiographic staging (Eaton II) predominated in the saddle configuration; advanced Eaton III-IV disease predominated in both cirque and dish shapes. Micro-CT verified the three discrete shapes with volardorsal and radioulnar orientation measurements. Conclusion The metacarpal surface of the trapezium demonstrates three distinct patterns of wear in arthritic surgical specimens. Sex, dominance, age distribution, and Eaton stage varied across the different shapes. Level of Evidence Level 3 Study Type Observational.

Relationship of Relaxin Hormone and Thumb Carpometacarpal Joint Arthritis

The female predominance in thumb carpometacarpal (CMC) joint arthritis has led to speculation that reproductive hormones or hypermobility are responsible. Evidence shows that patients with pathologic laxity have a higher rate of thumb CMC arthritis. Relaxin hormone increases laxity in the pelvic ligaments through upregulation of matrix metalloproteases (MMPs). It is thus a hormone of interest in the development of thumb CMC arthritis. Our goals were to identify demographic and hormonal factors associated with joint laxity in patients with CMC arthritis and to evaluate the relationship among serum relaxin, relaxin receptors, and MMPs in the anterior oblique ligament (AOL) of the thumb. We hypothesized that serum relaxin was correlated with joint laxity as well as with relaxin receptors and MMPs in the AOL. Forty-nine patients undergoing thumb CMC arthroplasty underwent laxity examination, blood draw, and AOL sampling. Ligaments were analyzed for relaxin receptor and MMPs 1 and 3 using quantitative reverse-transcriptase polymerase chain reaction. Women demonstrated more joint laxity than men (p < 0.001). RNA analysis confirmed relaxin receptors in the AOL as well as MMPs 1 and 3. There was a significant correlation between serum relaxin and MMP-1 (p = 0.04). Detectable serum relaxin was negatively correlated with relaxin receptors in the AOL (p = 0.02). Further studies are needed to evaluate the role of laxity and sex hormones in thumb CMC arthritis. Relaxin hormone may play a role in the development of arthritis at the thumb CMC joint. Level I, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Thumb Carpometacarpal Arthroplasty Using an Absorbable Interference Screw for Flexor Carpi Radialis Ligament Reconstruction

Few surgical techniques that address advanced thumb carpometacarpal osteoarthrosis specifically allow early mobilization postoperatively. After trapeziectomy, we carry out a ligament reconstruction using an absorbable interference screw to secure a flexor carpi radialis tendon autograft within the first metacarpal base. Theoretically, superior tendon graft fixation strength allows early mobilization within 2 weeks postoperatively. We have retrospectively compared our clinical results using this technique with another group of patients who underwent traditional ligament reconstruction and tendon interposition as described by Burton and Pellegrini. There were no differences in the verbal pain score, satisfaction rating, or DASH scores between groups. There was a statistically significant decrease in trapezial space ratio both at rest and with stress for the experimental group. Although the clinical significance of this finding is largely unknown, it did not correlate with clinical outcome in our patients. Although no conclusions could be drawn regarding early mobilization after thumb carpometacarpal arthroplasty, further studies are planned to investigate this intriguing aspect of postoperative care. In this article, we present the details of the surgical technique and postoperative rehabilitation.