Suture Suspension Arthroplasty With Trapeziectomy for Thumb Carpometacarpal Arthritis Using a Wide-awake Approach

Despite the introduction of various techniques for ligament reconstruction in the treatment of thumb carpometacarpal (CMC) arthritis, complications, including proximal migration, dorsal subluxation of the first metacarpal base, hyperextension of the thumb metacarpophalangeal joint, and impingement between the first and second metacarpal bases, have been reported. Even suture button suspensionplasty with Arthrex Mini TightRope may be unable to correct the adduction contracture deformity and does not effectively tether the trapeziometacarpal toward the base of the index metacarpal, thus potentially leaving patients with persistent decreased first web space angle, proximal migration, and collapse deformity. Hence, suture suspension arthroplasty with abductor pollicis longus (APL)-flexor carpi radialis (FCR) tendon suture after trapeziectomy, a simpler technique, was applied. This simple surgical reconstruction abducts the first metacarpal bone. Abduction of the CMC joint improves metacarpophalangeal joint hyperextension. However, strong tension of the APL-FCR causes abduction contracture of the first CMC joint and difficulty of pinch motion of the thumb to the other fingers. Therefore, we have modified the arthroplasty with a wide-awake approach. The procedure is performed with the patient fully awake under local anesthesia, without a tourniquet to allow the patient to actively move and pinch the thumb, which allows the surgeon to confirm the tension of the APL-FCR suture. A fiber wire is connected to the APL-FCR with proper tension. The patient and surgeon can ensure pinch motion and thumb opposition with satisfaction during surgery.