Arthroscopic Management of Thumb Carpometacarpal Joint Arthritis and Pathology

Arthroscopic Hemitrapeziectomy and Extensor Carpis Radialis Longus Suspensioplasty With Intermetacarpal Ligament Reconstruction for Thumb Carpometacarpal Joint Osteoarthritis: Surgical Technique

LEVEL OF EVIDENCE

Level IV.

Arthroscopic Trapeziectomy Without Traction Tower

Osteoarthritis in the thumb carpometacarpal joint causes pain, swelling, deformity, instability, loss of motion, and power, which seriously impairs overall hand function. Surgery is indicated if conservative treatment fails to relieve the pain. Trapeziectomy is the most popular surgical treatment choice and yields good range of motion and relieves pain with the fewest complications. Arthroscopic trapeziectomy is gaining popularity. In general, the arthroscopic procedure is performed under continuous traction with a traction tower. The purpose of this Technical Note is to describe the details of arthroscopic trapeziectomy without traction tower. This eliminates the need of a traction tower and continuous traction and provides a stable platform for the arthroscopic procedure.

Biomechanical Comparison of FiberLock Suspensionplasty and Flexor Carpi Radialis Ligament Reconstruction for Treatment of Thumb Carpometacarpal Osteoarthritis

BACKGROUND

The purpose of this study was to compare the cyclic and load to failure characteristics of post-trapeziectomy suspensionplasty with the FiberLock Suspension System (FLSS; Arthrex Inc., Naples, Florida) to flexor carpi radialis ligament reconstruction (FCRLR). We hypothesized that the FLSS will have increased stiffness, yield, and ultimate load compared with FCRLR.

METHODS

Ten matched pairs of cadaveric hands were used. One side of each pair was randomly assigned to receive the FCRLR or FLSS and the contralateral side received the other suspensionplasty. A complete trapeziectomy was performed followed by FLSS or FCRLR. Cyclic and load to failure characteristics were measured with loading in the distal to proximal direction. A preload of 1 N with 30 cycles of 1 N to 10 N was applied, followed by load to failure. A paired t test was used for statistical analysis (P < .05).

RESULTS

The FLSS had significantly decreased nonrecoverable deformation and deformation at peak load during cyclic loading (P < .04). The FLSS also had significantly increased stiffness, yield load, ultimate load, and load and energy absorbed at 10 mm displacement compared with FCRLR (P < .04). All 10 FCRLR specimens failed with suture tearing through the tendon. Nine FLSS specimens failed due to suture slipping from the SwiveLock anchor (Arthrex Inc., Naples, Florida) and 1 failed due to the FiberTak anchor (Arthrex Inc., Naples, Florida) pulling through the index metacarpal.

CONCLUSION

Suspensionplasty with the FLSS demonstrated greater structural integrity compared with FCRLR following trapeziectomy. The FLSS procedure may result in decreased thumb subsidence and decreased construct failure.

Evaluation of In Vivo Biocompatibility in Preclinical Studies of a Finger Implant Medical Device Correlated with Mechanical Properties and Microstructure

The aim of the experiment was to evaluate the biocompatibility of four 3D-printed biomaterials planned for use in the surgical treatment of finger amputees: Ti-6Al-4 V (Ti64), ZrO2-Al2O3 ceramic material (ATZ20), and osteoconductive (anodized Ti64) and antibacterial (Hydroxyapatite, HAp) coatings that adhere well to materials dedicated to finger bone implants. The work concerns the correlation of mechanical, microstructural, and biological properties of dedicated materials. Biological tests consisted of determining the overall cytotoxicity of the organism on the basis of in vivo tests carried out in accordance with the ISO 10993-6 and ISO 10993-11 standards. Clinical observations followed by diagnostic examinations, histopathological evaluation, and biochemical characterization showed no significant differences between control and tested groups of animals. The wound healed without complication, and no pathological effects were found. The wear test showed the fragility of the hydroxyapatite thin layer and the mechanical stability of the zirconia-based ceramic substrate. Electron microscopy observations revealed the layered structure of tested substrates and coatings.