Mini TightRope Suspensionplasty for Thumb Carpo-Metacarpal Arthritis- Four Year Followup

Orit Bain Uri Farkash Paul Sagiv
Hand Surgery Unit, Department of Orthopedic Surgery, Meir Medical Center, Kfar-Saba Affiliated with Sackler Faculty of Medicine, Tel Aviv University, Israel

The trapeziometacarpal joint is the second most commonly involved site of primary OA in the hand after DIP joint, affecting mainly women. Its involvement causes significant functional disability that may markedly interfere with activities of daily living.

Many operative options are used in treating this problem. The goals of operative treatment include pain relief, joint stability and improvement of hand function. Operative options are divided grossly to those settling with partial or total removal of the trapezium and those adding stabilizing procedures of the first metacarpal bone.

The Mini TightRope [MTR] is a newly developed technique of stabilizing the thumb metacarpal after trapezial resection. The MTR can also be used in revision of proximal migration after trapezectomy or as a stabilizer in CMC hyperlaxity. The construct consists of two strands of fiber wires which are fixed with two titanium buttons. After drilling a tunnel through the first and second metacarpal bones, the suture is passed through the bony tunnel and tightened over the metacarpals.

We present our experience with this procedure since 2012. Postoperatively the patients were treated with thumb spica for 2 weeks changed to thermoplastic spica for another 2 weeks. At that time active range of motion was initiated. At three months after the operation, most of the patients were independent in ADL functions and most household activities. The time of recovery was found to be shorter in according to patients treated with conventional LRTI. In this group of patients there were no infections, CRPS or extensor tendon injuries. Two patients complained of limitation of thumb abduction or pain over the buttons and had the MTR removed. Most of the metacarpal bones maintained their height in serial X- rays. We consider this technique as an easy, quick and safe procedure, saving the need of a donor. As with any surgical technique, there is a learning cure and careful attention must be paid to surgical steps and details.