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The Role of Arthroscopy in Trapeziometacarpal Arthritis

  • Symposium: Thumb Carpometacarpal Arthritis
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Trapeziometacarpal (TM) arthroscopy should be viewed as a useful minimally invasive adjunctive technique rather than the operation itself since it allows one to visualize the joint surface under high-power magnification with minimal disruption of the important ligamentous complex. Relatively few articles describe the arthroscopic treatment of TM osteoarthritis (OA) and the arthroscopic anatomy of the TM joint. There is lingering confusion as to whether soft tissue interposition and K-wire fixation of the joint are needed and whether the outcomes of arthroscopic procedures compare to the more standard open techniques for TM arthroplasty.

Questions/purposes

This paper describes (1) the arthroscopic ligamentous anatomy of the TM joint, (2) the portal anatomy and methodology behind TM arthroscopy, and (3) the arthroscopic treatment for TM OA, including the current clinical indications for TM arthroscopy and the expected outcomes from the literature.

Methods

A MEDLINE® search was used to retrieve papers using the search terms trapeziometacarpal, carpometacarpal, portal anatomy, arthroscopy portals, arthroscopy, arthroscopic, resection arthroplasty, and arthroscopic resection arthroplasty. Eighteen citations satisfied the search terms and were summarized.

Results

Careful wound spread technique is needed to prevent iatrogenic injury to the surrounding superficial radial nerve branches. Traction is essential to prevent chondral injury. Fluoroscopy should be used to help locate portals as necessary. Cadaver training is desirable before embarking on a clinical case. Questions regarding the use of temporary K-wire fixation or thermal shrinkage or the need for a natural or synthetic interposition substance cannot be answered at this time.

Conclusions

Longitudinal prospective studies are needed to answer these lingering questions. An intimate knowledge of the portal and arthroscopic anatomy is needed to perform TM arthroscopy. Minimally invasive techniques for resection arthroplasty in TM OA with and without soft tissue interposition can yield good outcomes in the treatment of TM OA.

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Authors and Affiliations

  1. Harbor-UCLA medical center, 2808 Columbia Street, Torrance, CA, 90503, USA

    David Joseph Slutsky MD

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  1. David Joseph Slutsky MD
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Correspondence to David Joseph Slutsky MD.

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Each author certifies that he or she, or a member of his or her immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

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Slutsky, D.J. The Role of Arthroscopy in Trapeziometacarpal Arthritis. Clin Orthop Relat Res 472, 1173–1183 (2014). https://doi.org/10.1007/s11999-012-2673-0

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  • DOI: https://doi.org/10.1007/s11999-012-2673-0

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