Suture-Button Stabilisation for Thumb Carpometacarpal Joint Instability and Dislocation: A Retrospective Case Series

Suture-button suspension is commonly used post trapeziectomy, stabilising the first metacarpal base to its adjacent counterpart. It has more recently been used in the setting of carpometacarpal instability, avoiding the morbidity of tendon harvest and large tunnels required in traditional stabilisation techniques. Evidence for its use in this setting remains limited.

A retrospective review of 13 consecutive patients, including 4 adolescents, with CMC1 instability treated with suture-button stabilisation by 2 fellowship-trained hand surgeons between 2018 and 2024 was performed. Mean follow-up was 11.8 months (3-24). Ten patients had chronic instability; 3 had acute traumatic dislocation with persistent instability. Outcomes included visual analog scale (VAS) pain scores, Kapandji scores, key pinch strength, complications, radiographic reduction, and return to work or sport.

Seven chronic instability patients had paired quantitative data. Mean VAS decreased by 4.43 points (P < .001), and mean Kapandji improved by 1.57 points (P = .042). The remaining 3 chronic instability patients reported improved pain, motion, and function; and achieved full opposition and stability at final follow-up. All acute dislocation patients regained stability, maintained reduction, and achieved full opposition with pain resolution by 12 weeks. Complications included 1 periprosthetic fracture, 1 corticosteroid injection for pain, and an elective button removal. All patients returned to work or sport by 12 weeks, with no fixation failures or recurrent subluxations.

Suture-button stabilisation provided reliable restoration of stability, pain relief, and early functional recovery. It may be considered an alternative to ligament reconstruction or Kirschner wire stabilisation in select patients.