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Kalshoven JM, Badida R, Morton AM, Molino J, Weiss APC, Ladd AL, Crisco JJ. The multidirectional roles of the anterior oblique ligament and dorsoradial ligament of the thumb carpometacarpal joint. J Orthop Res 2024. [PMID: 38923036 DOI: 10.1002/jor.25922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
The multidirectional biomechanics of the thumb carpometacarpal (CMC) joint underlie the remarkable power and precision of the thumb. Because of the unconfined nature of thumb CMC articulation, these biomechanics are largely dictated by ligaments, notably the anterior oblique ligament (AOL) and the dorsoradial ligament (DRL). However, the rotational and translational stabilizing roles of these ligaments remain unclear, as evidenced by the variety of interventions employed to treat altered pathological CMC biomechanics. The purpose of this study was to determine the effects of sectioning the AOL (n = 8) or DRL (n = 8) on thumb CMC joint biomechanics (rotational range-of-motion [ROM] and stiffness, translational ROM) in 26 rotational directions, including internal and external rotation, and in eight translational directions. Using a robotic musculoskeletal simulation system, the first metacarpal of each specimen (n = 16) was rotated and translated with respect to the trapezium to determine biomechanics before and after ligament sectioning. We observed the greatest increase in rotational ROM and decrease in rotational stiffness in flexion directions and internal rotation following DRL transection and in extension directions following AOL transection. The greatest increase in translational ROM was in dorsal and radial directions following DRL transection and in volar directions following AOL transection. These data suggest the AOL and DRL play complementary stabilizing roles, primarily restraining translations in the direction of and rotations away from the ligament insertion sites. These findings may inform future interventions or implant designs for pathological CMC joints.
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Affiliation(s)
- Josephine M Kalshoven
- Institute for Biology, Engineering, and Medicine, Brown University, Providence, Rhode Island, USA
| | - Rohit Badida
- Bioengineering Laboratory, Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
| | - Amy M Morton
- Bioengineering Laboratory, Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
| | - Janine Molino
- Bioengineering Laboratory, Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
- Lifespan Biostatistics, Epidemiology, Research Design and Informatics Core, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Arnold-Peter C Weiss
- Bioengineering Laboratory, Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
| | - Amy L Ladd
- Department of Orthopaedic Surgery, Robert A. Chase Hand & Upper Limb Center, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph J Crisco
- Institute for Biology, Engineering, and Medicine, Brown University, Providence, Rhode Island, USA
- Bioengineering Laboratory, Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, USA
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Bouredoucen H, Abs B, Ferreira Branco D, Buzzi M, Poletti PA, Piguet E, Beaulieu JY, Boudabbous S. Trapeziometacarpal joint imaging: Normal high-resolution MRI, US and CT compared with cadaveric specimens and pathological imaging findings. Eur J Radiol 2024; 177:111561. [PMID: 38897054 DOI: 10.1016/j.ejrad.2024.111561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION The trapeziometacarpal (TMC) joint is a complex joint, whose anatomy and function are different from the metacarpophalangeal joints of the long fingers. The stability of this joint is ensured at three levels by multiple structures: osteochondral, capsulo-ligamentous, and musculo-tendinous. The anatomical and biomechanical structures ensuring the stability of the TMC joint are perfectly evaluated on magnetic resonance imaging (MRI), with a high degree of confidence. All described ligaments are anatomically visible and perfectly assessed on MRI and ultrasound (US): the dorsoradial ligament, the posterior oblique ligament, the intermetacarpal ligament, the ulnar collateral ligament, the two bundles of the anterior oblique ligament (break ligament), as well as the superficial anterior oblique and deep anterior oblique ligaments. METHODOLOGY This educational review assesses the TMC joint anatomy using high-field MRI and US compared with cadaveric specimens as well the biomechanics of this joint. In addition, it highlights pathological patterns of traumatic (sprain, dislocation, and fractures) and degenerative diseases. RESULTS AND CONCLUSION Knowledge of TMC joint anatomy is crucial to the radiologists' understanding and assessment of various traumatic and degenerative pathologies, and thus helps clinicians and surgeons choose the appropriate treatment.
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Affiliation(s)
- Hicham Bouredoucen
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Bilal Abs
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - David Ferreira Branco
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Marcello Buzzi
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Pierre-Alexandre Poletti
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
| | - Emmanuel Piguet
- Division of Hand Surgery Unit, Department of Orthopedics, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Jean Yves Beaulieu
- Division of Hand Surgery Unit, Department of Orthopedics, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Sana Boudabbous
- Division of Radiology, Department of Imaging and Medical Informatics, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
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Kalshoven JM, Badida R, Morton AM, Molino J, Crisco JJ. The passive biomechanics of the thumb carpometacarpal joint: An in vitro study. J Biomech 2024; 168:112129. [PMID: 38703515 DOI: 10.1016/j.jbiomech.2024.112129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/05/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
The thumb carpometacarpal (CMC) joint facilitates multidirectional motion of the thumb and affords prehensile power and precision. Traditional methods of quantifying thumb CMC kinematics have been largely limited to range-of-motion (ROM) measurements in 4 orthogonal primary directions (flexion, extension, abduction, adduction) due to difficulties in capturing multidirectional thumb motion. However, important functional motions (e.g., opposition) consist of combinations of these primary directions, as well as coupled rotations (internal and external rotation) and translations. Our goal was to present a method of quantifying the multidirectional in vitro biomechanics of the thumb CMC joint in 6 degrees-of-freedom. A robotic musculoskeletal simulation system was used to manipulate CMC joints of 10 healthy specimens according to specimen-specific joint coordinate systems calculated from computed tomography bone models. To determine ROM and stiffness (K), the first metacarpal (MC1) was rotated with respect to the trapezium (TPM) to a terminal torque of 1 Nm in the four primary directions and in 20 combinations of these primary directions. ROM and K were also determined in internal and external rotation. We found multidirectional ROM was greatest and K least in directions oblique to the primary directions. We also found external rotation coupling with adduction-flexion and abduction-extension and internal rotation coupling with abduction-flexion and adduction-extension. Additionally, the translation of the proximal MC1 was predominantly radial during adduction and predominantly ulnar during abduction. The findings of this study aid in understanding thumb CMC joint mechanics and contextualize pathological changes for future treatment improvement.
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Affiliation(s)
- Josephine M Kalshoven
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, USA.
| | - Rohit Badida
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, USA.
| | - Amy M Morton
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, USA.
| | - Janine Molino
- Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, USA; Lifespan Biostatistics, Epidemiology, Research Design and Informatics Core, Rhode Island Hospital, Providence, RI 02903, USA.
| | - Joseph J Crisco
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, USA; Department of Orthopedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, USA.
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Shin SH, Shin SS, McGarry MH, Lee TQ. Internal brace augmentation improves the biomechanical properties of trapeziometacarpal joint dorsoradial ligament repair. HAND SURGERY & REHABILITATION 2024; 43:101643. [PMID: 38228245 DOI: 10.1016/j.hansur.2024.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/18/2024]
Abstract
This study investigated whether dorsoradial ligament repair with internal brace augmentation provided more immediate stability in the trapeziometacarpal joint than dorsoradial ligament repair alone. Seven matched pairs of cadaveric hands were used. One specimen from each pair was assigned to the repair-only group and the other to the repair + internal brace augmentation group. Trapeziometacarpal joint range of motion and translation were quantified under different conditions for both groups: (1) intact, (2) transected dorsoradial ligament, and (3) repaired dorsoradial ligament or repaired dorsoradial ligament plus internal brace augmentation. Load-to-failure tests were performed after repair. Range of motion and translation were increased by dorsoradial ligament transection and were decreased by dorsoradial ligament repair; however, compared to the intact condition, the repair-only group demonstrated greater flexion/extension range, while the repair + internal brace group showed no significant difference in range of motion. Mean loads at 2- and 3-mm displacements were greater in the repair + internal brace group than in the repair-only group (18.0 ± 1.8 N vs. 10.8 ± 1.3 N for 2 mm displacement and 35.3 ± 3.7 N vs. 23.1 ± 2.9 N for 3 mm displacement, respectively). Internal brace augmentation improved the load-to-failure characteristics of dorsoradial ligament repair without compromising range of motion. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Seung-Han Shin
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA; Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Steven S Shin
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA
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Valerio T, Milan JL, Goislard de Monsabert B, Vigouroux L. The effect of trapeziometacarpal joint passive stiffness on mechanical loadings of cartilages. J Biomech 2024; 166:112042. [PMID: 38498967 DOI: 10.1016/j.jbiomech.2024.112042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
Hypermobility of the trapeziometacarpal joint is commonly considered to be a potential risk factor for osteoarthritis. Nevertheless, the results remain controversial due to a lack of quantitative validation. The objective of this study was to evaluate the effect of joint laxity on the mechanical loadings of cartilage. A patient-specific finite element model of trapeziometacarpal joint passive stiffness was developed. The joint passive stiffness was modeled by creating linear springs all around the joint. The linear spring stiffness was determined by using an optimization process to fit force-displacement data measured during laxity tests performed on eight healthy volunteers. The estimated passive stiffness parameters were then included in a full thumb finite element simulation of a pinch grip task driven by muscle forces to evaluate the effect on trapeziometacarpal loading. The correlation between stiffness and the loading of cartilage in terms of joint contact pressure and maximum shear strain was analyzed. A significant negative correlation was found between the trapeziometacarpal joint passive stiffness and the contact pressure on trapezium cartilage during the simulated pinch grip task. These results therefore suggest that the hypermobility of the trapeziometacarpal joint could affect the contact pressure on trapezium cartilage and support the existence of an increased risk associated with hypermobility.
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Affiliation(s)
- Thomas Valerio
- Aix-Marseille University, CNRS, ISM, Marseille, France; Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France.
| | - Jean-Louis Milan
- Aix-Marseille University, CNRS, ISM, Marseille, France; Aix-Marseille University, APHM, CNRS, ISM, St Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, Marseille, France
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Jongen I, Nieuwdorp N, Hundepool C, Van Gelder F, Schutter A, Zuidam J. Ligament reconstruction in thumb carpometacarpal joint instability: A systematic review. JPRAS Open 2024; 39:237-248. [PMID: 38323100 PMCID: PMC10843995 DOI: 10.1016/j.jpra.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/07/2024] [Indexed: 02/08/2024] Open
Abstract
In thumb carpometacarpal (CMC) instability, laxity of the ligaments surrounding the joint leads to pain and weakness in grip and pinch strength, which predisposes the patient to developing CMC joint arthritis. Recent advancements in joint anatomy and kinematics have led to the development of various surgical reconstructive procedures. This systematic review outlines the available ligament reconstruction techniques and their efficacy in treating nontraumatic and nonarthritic CMC instability. Additionally, we aimed to provide evidence which specific ligament reconstruction technique demonstrates the best results. Four databases (Embase, MEDLINE, Web of Science, and Cochrane Central) were searched for studies that reported on surgical techniques and their clinical outcomes in patients with nontraumatic and nonarthritic CMC instability. Twelve studies were analyzed for qualitative review, including nine different surgical ligament reconstruction techniques involving two hundred and thirty thumbs. All but one of the reported techniques improved postoperative pain scores and showed substantial improvement in pinch and grip strength. Complication rates varied between 0% and 25%. The included studies showed that ligament reconstruction effectively alleviated the patients' complaints regarding pain and instability, resulting in overall high patient satisfaction. Nevertheless, drawing definitive conclusions regarding the superiority of any ligament reconstruction technique remains challenging owing to the limited availability of homogeneous data in the current literature.
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Affiliation(s)
- I.C. Jongen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GE Rotterdam, the Netherlands
| | - N.J. Nieuwdorp
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GE Rotterdam, the Netherlands
| | - C.A. Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GE Rotterdam, the Netherlands
| | - F.S. Van Gelder
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GE Rotterdam, the Netherlands
| | - A.M. Schutter
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GE Rotterdam, the Netherlands
| | - J.M. Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, Dr. Molewaterplein 40, 3015 GE Rotterdam, the Netherlands
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Ledoux P. Contribution to the study of stresses in the thumb column during key pinch grip. HAND SURGERY & REHABILITATION 2024; 43:101603. [PMID: 37806637 DOI: 10.1016/j.hansur.2023.09.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/08/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES The aim of this study was to calculate the stress acting on the trapeziometacarpal joint during an key pinch grip. METHOD We used profile X-rays of the thumb to measure the various bony and muscle lever arms. We assessed the angles of action of the muscular elements involved in the thumb column. Based on this data, we established a two-dimensional geometric model that enabled us to determine the forces at each joint level, as a function of stresses and muscular contributions. We were also able to calculate the participation of the different muscle groups in obtaining a balanced situation. RESULTS Our results, as a function of the degree of flexion of the interphalangeal and metacarpophalangeal joints, show a multiplying factor of 2.9-3.19 in relation to the key pinch grip force. DISCUSSION Previous studies modelling a key pinch grip are showed multiplying factors from 6 to 13 in relation to the key pinch grip force. They are not compatible with the characteristics of the polyethylene used for trapeziometacarpal prostheses, whereas numerous articles in the literature show survival rates that are more or less comparable to those of total hip prostheses. These studies required an excessive number of assumptions, which could lead to error. Our results are compatible with the results of trapeziometacarpal prosthesis and with those of a recent study measuring intra-articular trapeziometacarpal pressure in a cadaveric model. Our model allows us to test different configurations of the thumb spine depending on the degree of flexion of the interphalangeal and metacarpophalangeal joints.
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Affiliation(s)
- Pascal Ledoux
- Polyclinique des 3 Vallées, 4 Route de Saint Pons, 34600 Bédarieux, France.
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Kittithamvongs P, Uerpairojkit C, Wangtanabadeekul S, Anantavorasakul N, Malungpaishrope K, Leechavengvongs S. Dorsoradial Ligament Reconstruction in Trapeziometacarpal Joint Arthritis. Hand (N Y) 2023; 18:484-490. [PMID: 34259081 PMCID: PMC10152538 DOI: 10.1177/15589447211028924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The main purpose of the study is to present the alternative novel surgical technique in treating patients with trapeziometacarpal (TMC) joint arthritis using dorsoradial ligament (DRL) reconstruction technique and report the clinical outcomes. METHODS Patients who were diagnosed with TMC joint arthritis and underwent DRL reconstruction were evaluated. Visual analog pain score; Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score; grip, tip pinch, tripod pinch, and key pinch strengths along with range of motion of the thumb; and Kapandji score were recorded in the preoperative period and at follow-up. Stress examination was also performed under a fluoroscope. RESULTS Eleven patients were included in the study. Median follow-up time was 13 months. At follow-up, postoperative visual analog scale and QuickDASH score improved in all patients. Grip, tip pinch, tripod pinch, and key pinch strengths also improved. The range of motion and Kapandji score were slightly improved compared with the preoperative period except for the thumb metacarpophalangeal flexion. Two patients had numbness at the thumb and spontaneously recovered after 3 months. CONCLUSIONS According to recent evidence which proposed the importance of DRL in TMC joint stability, our DRL reconstruction technique may be an alternative treatment in treating patients presented with TMC joint arthritis. Further study with a longer follow-up period is needed.
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Kelmer GC, Johnson AH, Turcotte JJ, Shushan A. Chronic Dislocation of the Thumb Carpometacarpal Joint: A Case Report. Cureus 2023; 15:e38168. [PMID: 37261143 PMCID: PMC10226843 DOI: 10.7759/cureus.38168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
Dislocation of the thumb carpometacarpal (CMC) joint is a rare injury; chronic CMC dislocation can lead to significant disability. Traditionally, surgical intervention has focused on the reconstruction of the anterior oblique ligament, though more recently there has been more focus on the dorsoradial ligament. Consideration of both ligaments during CMC joint reconstruction is important to optimize functional outcomes. A 59-year-old male presented with a subacute/chronically dislocated CMC joint of the thumb. Open reduction with pin fixation and dorsoradial ligament repair and augmentation was chosen to restore the stability of the joint. Joint reduction without subluxation was successfully maintained. By 12 weeks postoperatively, there were no remaining major restrictions to activity. Repair of the dorsoradial ligament with augmentation and pinning is a viable approach for surgical management of subacute/chronic dislocation of the thumb CMC joint.
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Affiliation(s)
- Grayson C Kelmer
- Medical School, Campbell University School of Osteopathic Medicine, Lillington, USA
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Andrea H Johnson
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Justin J Turcotte
- Orthopedic Research, Luminis Health Anne Arundel Medical Center, Annapolis, USA
| | - Alexander Shushan
- Orthopedic Surgery, Luminis Health Anne Arundel Medical Center, Annapolis, USA
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Tandioy-Delgado FA, Marcovici LL, Luchetti R, Atzei A. Arthroscopic Assisted Treatment of Combined Trapezium and Bennett Fracture-Dislocation. Tech Hand Up Extrem Surg 2023; 27:30-37. [PMID: 35997265 DOI: 10.1097/bth.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Trapezium fractures are unusual; however, they represent the third most frequent fracture of the carpal bones. As they usually follow a high-energy trauma, they are associated with distal radius, Bennett, or Rolando fractures in 80% of cases. Traditional treatment options include, closed reduction and percutaneous pinning, or open reduction and internal fixation. To minimize the additional surgical trauma, an arthroscopic technique has been developed for safe, minimally invasive management of complex injuries of the first carpo-metacarpal joint. Intra-articular dislocated fracture fragments are reduced under direct visualization and fixed through small incisions. Limiting additional surgical damage on the carpo-metacarpal joint ligaments, capsule, and other soft tissues around the fracture preserves the blood supply to fracture fragments and also the proprioceptive system, which is key for the dynamic stability of such a hypermobile joint. This report confirms that the procedure is feasible, and a complete functional recovery can be expected with reduced postoperative rehabilitation.
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Affiliation(s)
| | | | | | - Andrea Atzei
- Pro-Mano, Hand Surgery and Rehabilitation, Treviso, Italy
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Minini A, Fagetti A, Tamborini F, Di Giovanna D, Salvi AG, Maffeis J, Sibona F, Cherubino M. Association of Acute Trapeziometacarpal Joint Dislocation and Trapezium Fracture in a 14-Year-Old Boy: A Case Report. Hand (N Y) 2023; 18:NP10-NP14. [PMID: 35642736 PMCID: PMC9806525 DOI: 10.1177/15589447221092121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fracture-dislocation of the trapeziometacarpal (TM) joint in adolescent patients is a rare injury, with only 3 cases reported in literature to our knowledge. Its low incidence, together with the complexity of the anatomy and biomechanics of TM joint, may represent a challenge for surgeons in choosing the best treating option. Here, we report a case of a TM fracture dislocation in a 14-year-old boy treated with percutaneous Kirschner wire pinning. The results we obtained endorsed our choice in patients for whom closed reduction is achievable.
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12
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Dong M, Kerkhof F, Deleu G, Vereecke E, Ladd A. Using a finite element model of the thumb to study Trapeziometacarpal joint contact during lateral pinch. Clin Biomech (Bristol, Avon) 2023; 101:105852. [PMID: 36521409 DOI: 10.1016/j.clinbiomech.2022.105852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/26/2022] [Accepted: 12/01/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Finite element (FE) analysis is widely used in different fields of orthopaedic surgery, however, its application to the trapeziometacarpal joint has been limited due to the small size, complex biconcave-convex joint geometry, and complex musculature. The goal of this study was to improve upon existing models by creating a muscle-driven FE thumb model and use the model to simulate the biomechanical effect of hand therapy exercises and ligament reconstructive surgeries. METHODS Bone and cartilage geometry were based on a CT dataset of a subject performing a static lateral pinch task. A previously validated musculoskeletal model was utilized to extract electromyography (EMG)-driven muscle forces. Five ligaments with biomechanical significance were modeled as springs using literature values and attached according to their anatomical landmarks. FINDINGS The biomechanical consequence of various interventions was proxied as a change in the maximum cartilage stress. The result shows tightening the dorsal ligament complex (dorsal radial ligament, dorsal central ligament, posterior oblique ligament) is the most effective, achieving a stress reduction of 4.8%. Five exercises used in hand therapies were modeled, among which thenar eminence strengthening showed the most prominent stress reduction of 4.0%. Four ligament reconstructive surgeries were modeled, with Eaton-Littler reconstruction showed the most significant stress reduction of 25.0%. INTERPRETATION Among the routinely utilized treatment options for early thumb osteoarthritis, we found that three methods: dorsal ligament imbrication, thenar eminence exercise, and the Eaton-Littler method may confer biomechanical advantages cartilage loading. These advantages align with the clinically observed favorable outcomes.
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Affiliation(s)
- Meilin Dong
- Stanford University School of Medicine, Stanford, CA, USA.
| | - Faes Kerkhof
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - GertJan Deleu
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie Vereecke
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
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van Leeuwen T, Vanneste M, D'Agostino P, Vereecke EE. Trapeziometacarpal joint mobility in gibbons (fam. Hylobatidae) and rhesus macaques (Macaca mulatta). AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022; 177:708-718. [PMID: 36787653 DOI: 10.1002/ajpa.24461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/15/2021] [Accepted: 11/22/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the differences in 3D kinematics of the trapeziometacarpal (TMC) joint between gibbons (fam. Hylobatidae) and macaques (Macaca mulatta), two non-human primate groups with a distinct locomotor behavior. Gibbons are highly arboreal species, while macaques are quadrupeds. Here, we investigate the mobility and structural constraints of the TMC joint in both these primates and evaluate the hypothesis that differences in locomotor mode are reflected in joint structure and function. MATERIALS AND METHODS We have developed an innovative software suite allowing for the quantification of in situ 3D kinematics based on medical imaging of the primate TMC joint using a unique sample of eight gibbons and seven macaques. These analyses are further supported by detailed dissection of the surrounding ligaments. RESULTS The data demonstrate distinct differences in TMC joint mobility between gibbons and macaques, with wide ranges of motion in the gibbon TMC joint and restricted movement in macaques. Furthermore, the dissections show little dissimilarity in ligament anatomy that could be associated with the differences in TMC joint capabilities. CONCLUSION We conclude that gibbons possess a highly mobile TMC joint and the ball-and-socket morphology allows for large ranges of motion. This type of morphology, however, does not offer much inherent stabilization. Lack of structural joint reinforcement suggests that gibbons may have difficulty in performing any type of power grasp with high loads. Macaques, on the other hand, are shown to have a considerably reinforced TMC joint, which is likely related to the habitual loading of the thumb during locomotion.
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Affiliation(s)
- Timo van Leeuwen
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Maarten Vanneste
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
| | - Priscilla D'Agostino
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven, Leuven, Belgium.,Louise Medical Center, Hand Clinic, Brussels, Belgium
| | - Evie E Vereecke
- Department of Development and Regeneration, Biomedical Sciences Group, KU Leuven, Leuven, Belgium
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14
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Abstract
The basal joint complex of the thumb provides the framework necessary for function of the human hand. Although its unique saddle articulation allows for a wide range of motion necessary for routine function of the hand, it is rendered inherently unstable because of poor bony congruency and reliance on its capsuloligamentous support. Painful instability of this joint can stem from several causes including traumatic dislocation, various hypermobility conditions, and chronic overuse and microtrauma. A thorough history and examination as well adequate imaging is necessary for proper evaluation of instability. Treatment options range from nonoperative modalities to surgery, which entails closed, percutaneous, or open reduction with numerous ligament repair and reconstruction techniques. Arthroscopy can also serve to be a useful adjunct for assessment of the joint and stabilization of the critical capsuloligamentous structures. This review outlines the critical osseous and soft-tissue anatomy surrounding the thumb carpometacarpal joint, the key points in evaluating patients presenting with acute traumatic and chronic thumb carpometacarpal instability without fracture or arthritis, and reviews both nonoperative and operative treatments of this injury.
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15
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Rusli WMR, Mirza E, Tolerton S, Yong S, Johnson R, Horwitz MD, Kedgley AE. Ligamentous constraint of the first carpometacarpal joint. J Biomech 2021; 128:110789. [PMID: 34653871 DOI: 10.1016/j.jbiomech.2021.110789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
To examine the role of the ligaments in maintaining stability of the first carpometacarpal (CMC) joint, a sequential ligament sectioning study of sixteen specimens was performed. While a small compressive force was maintained, loads were applied to displace each specimen in four directions - volar, dorsal, radial, and ulnar. Translations of the specimen in both dorsal-volar and radial-ulnar axes were measured. Initially, the tests were conducted with the specimen intact. These tests were then repeated following sectioning of the CMC anterior oblique ligament (AOL), ulnar collateral ligament (UCL), intermetacarpal ligament (IML) and dorsal radial ligament (DRL). The first CMC joint translation was increased in the absence of IML and DRL (p < 0.05). Both IML and DRL were important in constraining the first CMC joint translation against external applied loads. Potential applications of these findings include the treatment of joint hypermobility and the reduction or delay of onset or progression of first CMC joint osteoarthritis.
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Affiliation(s)
- Wan M R Rusli
- Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Eushaa Mirza
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Sarah Tolerton
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Sarah Yong
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Riem Johnson
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Maxim D Horwitz
- Department of Hand Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Angela E Kedgley
- Department of Bioengineering, Imperial College London, London, United Kingdom.
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16
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Fontaine C, D'Agostino P, Maes-Clavier C, Boutan M, Sturbois-Nachef N. Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints. HAND SURGERY & REHABILITATION 2021; 40S:S3-S14. [PMID: 34118467 DOI: 10.1016/j.hansur.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/18/2020] [Accepted: 09/29/2020] [Indexed: 10/21/2022]
Abstract
Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.
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Affiliation(s)
- C Fontaine
- Laboratoire d'Anatomie et Organogenèse, Faculté de Médecine Henri Warembourg, Université de Lille, Rue Michel Polonovski, 59045 Lille cedex, France; Laboratoire d'Automatique, de Mécanique et d'Informatique Industrielle et Humaine LAMIH, Université de Valenciennes et du Hainaut-Cambrésis, Le Mont Houy, 59313 Valenciennes cedex, France; Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France.
| | - P D'Agostino
- Clinique de la Main, Bruxelles et Brabant-Wallon, Avenue Louise 284, 1050 Bruxelles, Belgique
| | - C Maes-Clavier
- Service de Chirurgie Orthopédique et Traumatologique, CHU Amiens-Picardie, Site sud Route départementale 408, 80054 Amiens cedex 1, France
| | - M Boutan
- Résidence Dryades, Bâtiment A1, 1, rue du 11 novembre, 40990 Saint-Paul-les-Dax, France
| | - N Sturbois-Nachef
- Clinique de Traumatologie-Orthopédie, Hôpital Roger Salengro, Rue du Professeur Emile Laine, CHRU de Lille, 59037 Lille cedex, France
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17
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Anderson SR, Harrison LM, Wimalawansa SM. Snapping Extensor Pollicis Longus Tendon Subluxation Secondary to Trapeziometacarpal Instability: Case Report and Technique. JBJS Case Connect 2021; 11:01709767-202103000-00062. [PMID: 33764926 DOI: 10.2106/jbjs.cc.20.00478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 20-year-old woman presented with painful, snapping extensor pollicis longus (EPL) tendon subluxation and trapeziometacarpal (TMC) joint instability. Hemi-extensor carpi radialis longus (ECRL) tendon autograft stabilized the TMC joint, reconstructing the 1-2 intermetacarpal ligament. The subluxed EPL tendon was centralized over the dorsal first metacarpal by tightening the metacarpophalangeal radial sagittal band and creating a dorsal first metacarpal "neosheath" pulley using ECRL graft remnant. Postoperative rehabilitation included Spica bracing and immediate thumb interphalangeal joint exercises. CONCLUSION The patient's pain due to EPL tendon subluxation and TMC joint instability completely resolved. Postoperative thumb range of motion and function were equivalent to the nonaffected side.
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Affiliation(s)
- Spencer R Anderson
- Department of Orthopaedic and Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Lucas M Harrison
- Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Sunishka M Wimalawansa
- Department of Orthopaedic and Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio
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18
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Affiliation(s)
- Matthew T Brown
- Fellow in Hand & Wrist Surgery, Hooper Hand Unit, St John's Hospital, Livingston, West Lothian EH54 6PP, United Kingdom.
| | - Philippa A Rust
- Consultant Hand & Wrist Surgeon, Hooper Hand Unit, St John's Hospital, Livingston, West Lothian EH54 6PP, United Kingdom
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19
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Norton NM, Barnds B, McIff TE, Bruce TE, Fischer KJ. The Effect of the Joint Capsule and Anterior Oblique Ligament on Dorsal Subluxation of the First Metacarpal During Key Pinch. J Biomech Eng 2020; 142:1074591. [PMID: 32060509 DOI: 10.1115/1.4046364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 11/08/2022]
Abstract
Laxity of the anterior oblique ligament (AOL) and/or the dorsoradial ligament (DRL) are believed to contribute to the progression of osteoarthritis in the trapeziometacarpal joint through increased dorsal subluxation. Stress radiographs during functional tasks, such as key pinch, can be used to evaluate such joint instability. Cadaveric experiments can explore joint contact pressures as well as subluxation under varying conditions, to gain knowledge about joint mechanics. The disturbance of supporting tissues, such as the joint capsule, during experiments may affect the recorded stability of the joint. To evaluate potential effects of opening the joint capsule and severing the AOL, eleven cadaveric specimens were rigged to simulate key pinch. An anteroposterior (AP) radiograph of the hand was recorded for each specimen while intact, after partially opening the joint capsule and after sectioning the AOL. First metacarpal subluxation levels were compared between the intact joint, partially open joint capsule, and sectioned AOL. Neither opening the joint capsule nor cutting the AOL had a statistically significant effect on metacarpal subluxation. The results indicate that partially opening the joint capsule has a negligible effect on joint mechanics and support recent studies that postulate that the AOL plays a less substantial role in preventing subluxation.
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Affiliation(s)
- Nolan M Norton
- Bioengineering Program, University of Kansas, Lawrence, KS 66045
| | - Brandon Barnds
- Orthopedics and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160
| | - Terence E McIff
- Bioengineering Program, University of Kansas, Lawrence, KS 66045; Orthopedics and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160
| | - Toby E Bruce
- Orthopedics and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160
| | - Kenneth J Fischer
- Bioengineering Program, University of Kansas, Lawrence, KS 66045; Orthopedics and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160; Mechanical Engineering, University of Kansas, Lawrence, KS 66045
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20
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Weintraub MD, Hansford BG, Stilwill SE, Allen H, Leake RL, Hanrahan CJ, Chan BY, Soltanolkotabi M, Kobes P, Mills MK. Avulsion Injuries of the Hand and Wrist. Radiographics 2020; 40:163-180. [DOI: 10.1148/rg.2020190085] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michael D. Weintraub
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Barry G. Hansford
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Sarah E. Stilwill
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Richard L. Leake
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Christopher J. Hanrahan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Maryam Soltanolkotabi
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Patrick Kobes
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
| | - Megan K. Mills
- From the Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E #1A071, Salt Lake City, UT 84132 (M.D.W., S.E.S., H.A., R.L.L., C.J.H., B.Y.C., M.S., P.K., M.K.M.); and Department of Diagnostic Radiology, Oregon Health and Science University, Portland, Ore (B.G.H.)
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21
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Nanno M, Kodera N, Tomori Y, Takai S. Novel Modification of Abductor Pollicis Longus Suspension Arthroplasty with Trapeziectomy for Thumb Carpometacarpal Osteoarthritis. J NIPPON MED SCH 2019; 86:269-278. [PMID: 31308312 DOI: 10.1272/jnms.jnms.2019_86-507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We compared the clinical results of a newly modified abductor pollicis longus (APL) suspension arthroplasty with trapeziectomy procedure (modified Thompson procedure) with those of the original APL suspension arthroplasty with trapeziectomy procedure (original Thompson procedure) for treatment of advanced osteoarthritis of the thumb carpometacarpal (CMC) joint and assessed the effectiveness of the modified Thompson procedure for thumb CMC osteoarthritis. METHODS Ten hands of 10 patients (Group 1) were treated with the original Thompson procedure. Twenty hands of 16 patients (Group 2) were treated with the modified Thompson procedure, in which the bone tunnel positions were rearranged for a more dorsoradial passage of the transferred APL. RESULTS Significant differences between values before and after surgery were noted in thumb palmar and radial abduction angles, pinch power, grip strength, Quick Disability of Arm, Shoulder, and Hand questionnaire (Quick DASH) score, and visual analog scale (VAS) score. There was no statistically significant difference in thumb palmar abduction angle, pinch power, grip strength, Quick DASH score, or VAS score between Groups 1 and 2. However, range of motion of radial abduction in the thumb was significantly better for patients in Group 2 than for those in Group 1. CONCLUSIONS The modified Thompson procedure is a simple, effective technique that results in greater improvement in thumb radial abduction angle, as compared with the original technique, in patients with advanced thumb CMC osteoarthritis. Additionally, the modified technique is as useful as the original procedure for early restoration of thumb function and pain relief.
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Affiliation(s)
| | - Norie Kodera
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Yuji Tomori
- Department of Orthopaedic Surgery, Nippon Medical School
| | - Shinro Takai
- Department of Orthopaedic Surgery, Nippon Medical School
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22
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Wang KK, Zhang X, McCombe D, Ackland DC, Ek ET, Tham SK. Quantitative analysis of in-vivo thumb carpometacarpal joint kinematics using four-dimensional computed tomography. J Hand Surg Eur Vol 2018; 43:1088-1097. [PMID: 30068246 DOI: 10.1177/1753193418789828] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to define the normal thumb carpometacarpal joint kinematics in-vivo during opposition and abduction using four-dimensional computed-tomography in four volunteers. Movement of the metacarpal relative to the trapezium was quantified using both Euler and helical axis representations. Articular surface contact patterns were also analysed. The overall axis of rotation for the movement of opposition and abduction passes through the trapezium and the base of the proximal phalanx, respectively. An abrupt change in instantaneous axis of rotation at terminal opposition was found. Ligament modelling shows dorsoradial ligament becomes tauter towards terminal opposition, whereas anterior oblique ligament becomes more slack. These results support the existence of the 'screw-home' pivot at terminal opposition and the importance of the dorsoradial ligament for stability in this position. The normal reference set in this study can help establish a diagnostic tool for subtle carpometacarpal instability, or for evaluating efficacy of surgery.
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Affiliation(s)
- Kemble K Wang
- 1 Hand Surgery Unit, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia
| | - Xin Zhang
- 2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,3 Department of Biomechanical Engineering, University of Melbourne, Melbourne, Australia
| | - David McCombe
- 2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,4 Hand Surgery Unit, St Vincent's Hospital, Melbourne, Australia
| | - David C Ackland
- 2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,3 Department of Biomechanical Engineering, University of Melbourne, Melbourne, Australia
| | - Eugene T Ek
- 1 Hand Surgery Unit, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia
| | - Stephen K Tham
- 1 Hand Surgery Unit, Dandenong Hospital, Monash University, Melbourne, Australia.,2 Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute, Melbourne, Australia.,4 Hand Surgery Unit, St Vincent's Hospital, Melbourne, Australia
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23
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van Leeuwen T, Vanneste M, Kerkhof FD, D’agostino P, Vanhoof MJM, Stevens JMG, Harry van Lenthe G, Vereecke EE. Mobility and structural constraints of the bonobo trapeziometacarpal joint. Biol J Linn Soc Lond 2018. [DOI: 10.1093/biolinnean/bly162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Timo van Leeuwen
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Maarten Vanneste
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Faes D Kerkhof
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Priscilla D’agostino
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Marie J M Vanhoof
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
| | - Jeroen M G Stevens
- Centre for Research and Conservation, Royal Zoological Society Antwerp, Belgium
- Behavioural Ecology and Ecophysiology Group, University of Antwerp, Belgium
| | - G Harry van Lenthe
- Biomechanics Section, Department of Mechanical Engineering, University of Leuven, Leuven, Belgium
| | - Evie E Vereecke
- Muscles & Movement, Biomedical Sciences Group, University of Leuven Campus Kulak, Kortrijk, Belgium
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24
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Kerkhof FD, Vereecke EE, Vanovermeire O, Vanhaecke J, Vanneste M, Stockmans F. Trapeziometacarpal stabilization through dorsoradial ligament reconstruction: An early post-surgery in vivo biomechanical analyses. J Orthop Res 2018; 36:2851-2864. [PMID: 29947128 DOI: 10.1002/jor.24103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 06/18/2018] [Indexed: 02/04/2023]
Abstract
Ligament reconstruction can provide pain relief in patients with a painful, unstable, pre-arthritic trapeziometacarpal (TMC) joint. Imbrication of the dorsoradial ligament (DRL) has been proposed as a minimal invasive stabilization technique. It requires less invasive surgery than an Eaton-Littler technique and shows promising long-term clinical outcome. We used dynamic CT to objectively review the effects of the imbrication. Four patients with pain and laxity at the TMC joint, but without radiographic signs of osteoarthritis, were recruited. Dynamic CT scans were made during active thumb abduction-adduction, flexion-extension, and two functional grip tasks using a radiolucent jig. Scans of the patients were acquired before and 3 to 6 months after DRL reconstruction. Motion of each bone in the articular chain of the thumb was quantified. In addition, we mapped changes in the contact patterns between the articular facets during the entire thumb motion. After DRL imbrication, we found no overall decrease in MC1 movement in three out of four patients. Furthermore, no increase in TMC joint congruency, defined as proximity area size, was found for three out of four patients. Pre- and post-operative differences in congruency across different tasks were patient-dependent and relatively small. We demonstrated that, from a biomechanical perspective, there is high variability in post-operative outcome between patients that undergo identical surgical procedures performed by the same surgeon. A post-operative decrease in range of motion, increase in joint congruency or decrease in proximity area shift during thumb motion is not omnipresent. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2851-2864, 2018.
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Affiliation(s)
- Faes D Kerkhof
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Evie E Vereecke
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | | | | | - Maarten Vanneste
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium
| | - Filip Stockmans
- Department of Development and Regeneration, KU Leuven Campus Kulak, Kortrijk, Belgium.,AZ Groeninge, Kortrijk, Belgium
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26
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Trapezium Fracture Associated with Thumb Carpometacarpal Joint Dislocation: A Report of Three Cases and Literature Review. Case Rep Orthop 2018; 2018:2408708. [PMID: 29682377 PMCID: PMC5841103 DOI: 10.1155/2018/2408708] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 01/22/2018] [Indexed: 11/26/2022] Open
Abstract
Isolated trapezium fracture in combination with thumb carpometacarpal (CMC) joint dislocation is extremely rare, and no treatment consensus exists. Herein, we report 3 successfully treated cases of isolated trapezium fracture with thumb CMC joint dislocation. While good short-term results have been reported in the literature, the possibility of substantial ligament injuries that can lead to future instability of the thumb CMC joint must be noted. In order to obtain an excellent long-term clinical result, we propose the consideration of the anatomical repair of the CMC joint in terms of both bony and ligamentous structures in cases where instability remains after fracture fixation.
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27
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D'Agostino P, Dourthe B, Kerkhof F, Stockmans F, Vereecke EE. In vivo kinematics of the thumb during flexion and adduction motion: Evidence for a screw-home mechanism. J Orthop Res 2017; 35:1556-1564. [PMID: 27606961 DOI: 10.1002/jor.23421] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 09/06/2016] [Indexed: 02/04/2023]
Abstract
The thumb plays a crucial role in basic hand function. However, the kinematics of its entire articular chain have not yet been quantified. Such investigation is essential to improve our understanding of thumb function and to develop better strategies to treat thumb joint pathologies. The primary objective of this study is to quantify the in vivo kinematics of the trapeziometacarpal (TMC) and scaphotrapezial (ST) joints during flexion and adduction of the thumb. In addition, we want to evaluate the potential coupling between the TMC and ST joints during these tasks. The hand of 16 asymptomatic women without signs of thumb osteoarthritis were CT scanned in positions of maximal thumb extension, flexion, abduction, and adduction. The CT images were segmented and three-dimensional surface models of the radius, scaphoid, trapezium, and the first metacarpal were created for each thumb motion. The corresponding rotations angles, translations, and helical axes were calculated for each sequence. The analysis shows that flexion and adduction of the thumb result in a three-dimensional rotation and translation of the entire articular chain, including the trapezium and scaphoid. A wider range of motion is observed for the first metacarpal, which displays a clear axial rotation. The coupling of axial rotation of the first metacarpal with flexion and abduction during thumb flexion supports the existence of a screw-home mechanism in the TMC joint. In addition, our results point to a potential motion coupling between the TMC and ST joints and underline the complexity of thumb kinematics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1556-1564, 2017.
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Affiliation(s)
- Priscilla D'Agostino
- Department of Development and Regeneration, Muscles and Movement, Biomedical Sciences Group, KU Leuven Kulak, Etienne Sabbelaan 53, B-8500 Kortrijk, Belgium.,Louise Hand Clinic, Brussels, Belgium.,Europe Clinic, St-Elisabeth Clinic, Brussels, Belgium
| | - Benjamin Dourthe
- Department of Development and Regeneration, Muscles and Movement, Biomedical Sciences Group, KU Leuven Kulak, Etienne Sabbelaan 53, B-8500 Kortrijk, Belgium
| | - Faes Kerkhof
- Department of Development and Regeneration, Muscles and Movement, Biomedical Sciences Group, KU Leuven Kulak, Etienne Sabbelaan 53, B-8500 Kortrijk, Belgium
| | - Filip Stockmans
- Department of Development and Regeneration, Muscles and Movement, Biomedical Sciences Group, KU Leuven Kulak, Etienne Sabbelaan 53, B-8500 Kortrijk, Belgium.,Handgroep, AZ Groeninge, Kortrijk, Belgium
| | - Evie E Vereecke
- Department of Development and Regeneration, Muscles and Movement, Biomedical Sciences Group, KU Leuven Kulak, Etienne Sabbelaan 53, B-8500 Kortrijk, Belgium
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He S, Xu L, Zhao S, Huang F. [Biomechanical evaluation of the first carpometacarpal joint stability by using different reconstruction methods]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:171-175. [PMID: 29786248 DOI: 10.7507/1002-1892.201610035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method. Methods The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups: normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models (injury group); after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton-Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus. Results During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were (11.61±0.20), (5.39±0.12), (6.33±0.10), (7.12±0.08), and (8.30±0.10) MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups ( P<0.05). Conclusion Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint. And the effect of volar-dorsal ligament reconstruction is the best, but the stability can not restore to normal.
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Affiliation(s)
- Shukun He
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | | | - Sichun Zhao
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Fuguo Huang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Chenoweth BA, O'Mahony GD, Fitzgerald C, Stoner JA, O'Donoghue DL, Rayan GM. Efficacy of Dorsoradial Capsulodesis for Trapeziometacarpal Joint Instability: A Cadaver Study. J Hand Surg Am 2017; 42:e25-e31. [PMID: 28052834 DOI: 10.1016/j.jhsa.2016.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 09/02/2016] [Accepted: 11/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the biomechanical properties of the dorsoradial capsulodesis procedure. METHODS Six cadaveric hands were used. After exposing the trapeziometacarpal (TMC) joint, we placed Kirschner wires in the distal radius and thumb metacarpal. The rotation shear test was then performed to test the joint axial laxity, and angular measurements using Kirschner wires as reference points were documented. The dorsoradial (DR) ligament and capsule were released, followed by the intermetacarpal (IM) ligament; angular measurements were obtained. Finally, the DR capsulodesis procedure was performed, and final measurements were obtained. Comparisons were made among the various stages of ligament integrity to determine the amount of stability provided by DR capsulodesis. RESULTS All cadavers demonstrated axial laxity with transection of the DR ligament; an increase in stability was obtained after DR capsulodesis. Transection of the capsule and IM ligament caused increased laxity relative to the native joint (median, 24° and 35°, respectively, on rotational testing). After we performed DR capsulodesis, rotational stability improved by a median of 41° compared with DR ligament transection, 49° compared with DR and IM ligament transection, and 18° relative to the native joint. CONCLUSIONS Dorsoradial capsulodesis restores rotational stability for TMC joint after division of the DR and IM ligaments. The stability achieved was statistically significant compared with both an intact native TMC joint and induced laxity of the TMC joint. CLINICAL RELEVANCE The DR capsulodesis procedure may improve rotational stability to the TMC joint.
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Affiliation(s)
- Brian A Chenoweth
- Department of Orthopedic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, OK
| | - Gavin D O'Mahony
- Department of Orthopedic Surgery, College of Medicine, University of Oklahoma, Oklahoma City, OK
| | - Casey Fitzgerald
- University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, College of Public Health, University of Oklahoma, Oklahoma City, OK
| | - Daniel L O'Donoghue
- Department of Cell Biology, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, OK
| | - Ghazi M Rayan
- Hand Surgery Division, INTEGRIS Baptist Medical Center, Oklahoma City, OK.
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Esplugas M, Lluch-Bergada A, Mobargha N, Llusa-Perez M, Hagert E, Garcia-Elias M. Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy. J Wrist Surg 2016; 5:277-283. [PMID: 27777818 PMCID: PMC5074831 DOI: 10.1055/s-0036-1581052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ. Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05. Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p = 0.004). Conclusion Sectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers. Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.
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Affiliation(s)
| | | | - Nathalie Mobargha
- Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden
- Department of Hand and Plastic Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Manuel Llusa-Perez
- Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Elisabet Hagert
- Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden
- Hand and Foot Surgery Center, Stockholm, Sweden
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Spekreijse KR, Vermeulen GM, Moojen TM, Slijper HP, Hovius SER, Selles RW, Feitz R. Surgical stabilization for symptomatic carpometacarpal hypermobility; a randomized comparison of a dorsal and a volar technique and a cohort of the volar technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016; 39:345-352. [PMID: 27729715 PMCID: PMC5031748 DOI: 10.1007/s00238-016-1212-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypermobility of the first carpometacarpal joint is mostly surgically treated with a volar approached stabilization by Eaton, but recent studies indicate the importance of the dorsoradial and intermetacarpal ligaments (DRL and IML) for carpometacarpal joint stability. The aim of this study was to compare a dorsal and volar technique for primary carpometacarpal hypermobility regarding pain and functional outcome. METHODS Patients with non-degenerative, painful carpometacarpal hypermobility were included and were randomly assigned to either the volar technique using the FCR, or a dorsal technique using the ECRL. After premature termination of the trial, we followed all patients treated with the volar approach. Pain, strength, and ADL function using DASH and Michigan Hand Questionnaires (MHQ) were measured at baseline and 3 and 12 months after surgery. RESULTS After including 16 patients, the randomized trial comparing the volar and dorsal technique was terminated because of significant increased pain in the dorsal group. Although none of the other outcome measures were significant in the underpowered comparison, in line with the pain scores, all variables showed a trend towards a worse outcome in the dorsal group. Between 2009 and 2012, 57 thumbs were surgically stabilized. We found significant better pain and MHQ scores, and after 1 year improved grip and key pinch strength. Patients returned to work within 8 (±7) weeks, of which 85 % in their original job. CONCLUSIONS Surgical stabilization of the thumb is an effective method for patients suffering from hypermobility regarding pain, daily function, and strength. We recommend a volar approach. Level of Evidence: Level I, therapeutic study.
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Affiliation(s)
- Kim Robin Spekreijse
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands
| | - Guus Maarten Vermeulen
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands
| | - Thybout M Moojen
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands
| | - Harm P Slijper
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands
| | - Steven E R Hovius
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ruud W Selles
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Reinier Feitz
- Division of Plastic, Reconstructive and Hand surgery, Erasmus Medical Center, Rotterdam, the Netherlands ; Division of Hand surgery, Xpert Clinic, Hilversum, the Netherlands
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Use of the entire flexor carpi radialis tendon for basal thumb ligament reconstruction interposition arthroplasty. HAND SURGERY & REHABILITATION 2016; 35:107-13. [DOI: 10.1016/j.hansur.2016.01.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/27/2015] [Accepted: 01/10/2016] [Indexed: 11/20/2022]
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Bilge O, Karalezli N. Current review of trapeziometacarpal osteoarthritis (rhizarthrosis). World J Rheumatol 2015; 5:90-95. [DOI: 10.5499/wjr.v5.i2.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 12/05/2014] [Accepted: 03/18/2015] [Indexed: 02/06/2023] Open
Abstract
Trapeziometacarpal (TMC) joint is the secondly affected joint for osteoarthritis in the hand. TMC joint arthritis affects most commonly postmenopausal women after the fifth decade of life, due to hormonal and structural factors. Rhizarthrosis may lead to a clinical spectrum from subtle symptoms to advanced symptoms such as; severe pain, limitation of range of motion, muscular weakness, bony deformities, and end up ultimately with disability. Regardless of the etiopathogenesis; a variety of non-surgical and surgical methods have been used for the treatment of rhizarthrosis, depending on the age of the patient, symptomatology and the stage of the disease. The main goals of the treatments are as follows; relief of pain, conservation or restoration the stability and mobility of the TMC joint with the optimal preservation of the strength of surrounding musculature. In this article, the current methods, which have been used for the treatment of TMC joint osteoarthritis, will be mainly reviewed, together with concise up-to-date information on both its diagnosis and the anatomy of the TMC joint.
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Halilaj E, Rainbow MJ, Moore DC, Laidlaw DH, Weiss APC, Ladd AL, Crisco JJ. In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint. J Biomech 2015; 48:1893-8. [PMID: 25964211 DOI: 10.1016/j.jbiomech.2015.04.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 03/24/2015] [Accepted: 04/20/2015] [Indexed: 01/16/2023]
Abstract
The anterior oblique ligament (AOL) and the dorsoradial ligament (DRL) are both regarded as mechanical stabilizers of the thumb carpometacarpal (CMC) joint, which in older women is often affected by osteoarthritis. Inferences on the potential relationship of these ligaments to joint pathomechanics are based on clinical experience and studies of cadaveric tissue, but their functions has been studied sparsely in vivo. The purpose of this study was to gain insight into the functions of the AOL and DRL using in vivo joint kinematics data. The thumbs of 44 healthy subjects were imaged with a clinical computed tomography scanner in functional-task and thumb range-of-motion positions. The origins and insertion sites of the AOL and the DRL were identified on the three-dimensional bone models and each ligament was modeled as a set of three fibers whose lengths were the minimum distances between insertion sites. Ligament recruitment, which represented ligament length as a percentage of the maximum length across the scanned positions, was computed for each position and related to joint posture. Mean AOL recruitment was lower than 91% across the CMC range of motion, whereas mean DRL recruitment was generally higher than 91% in abduction and flexion. Under the assumption that ligaments do not strain by more than 10% physiologically, our findings of mean ligament recruitments across the CMC range of motion indicate that the AOL is likely slack during most physiological positions, whereas the DRL may be taut and therefore support the joint in positions of CMC joint abduction and flexion.
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Affiliation(s)
- Eni Halilaj
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, United States
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Douglas C Moore
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States
| | - David H Laidlaw
- Department of Computer Science, Brown University, Providence, RI 02912, United States
| | - Arnold-Peter C Weiss
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States
| | - Amy L Ladd
- Robert A. Chase Hand & Upper Limb Center, Department of Ortho paedic Surgery, Stanford University, Stanford, CA 94304, United States
| | - Joseph J Crisco
- Center for Biomedical Engineering and School of Engineering, Brown University, Providence, RI 02912, United States; Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI 02903, United States.
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Abstract
Thumb ligament injuries are common, particularly those involving the metacarpophalangeal joint. Our understanding and treatment of these injuries continues to evolve. This article provides a comprehensive review of recent literature with updates pertaining to the anatomy, function, diagnosis, and treatment of thumb ligament injuries.
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