Does Arthroscopic Débridement With or Without Interposition Material Address Carpometacarpal Arthritis?
Julie E. Adams MD
Symposium: Thumb Carpometacarpal Arthritis
Online First ™ -
March ,
2013
Abstract
Background
Thumb carpometacarpal (CMC) joint arthritis is a common problem in
clinical practice with a variety of treatment options. Arthroscopic
procedures can preserve all or part of the trapezium in the setting of
treatment of basilar joint arthritis, and such procedures (even without
stabilization or ligament reconstruction) have high reported success
rates. However, little is documented about the limitations of these
procedures in terms of patient selection, the optimal type of
interposition, if any, and rehabilitation.
Questions/purposes
A systematic review was performed to determine the influence of (1)
interposition material (manufactured, biological, or none); and (2)
patient-related factors (including metacarpophalangeal joint
hyperextension, ligamentous laxity, and severity of arthritis) on pain,
functional scores, and postoperative complications unique to each
approach.
Methods
A systematic review of the English language literature regarding
thumb basilar joint arthritis and arthroscopic partial trapeziectomy or
débridement was performed. Those procedures including ligament
reconstruction or stabilization were excluded.
Results
Biological materials and no interposition were both associated with
satisfactory improvement and low rates of complications; complication
rates with synthetic materials were higher. Eaton Stages I to III were
treated successfully with this technique. The effect of
scaphotrapeziotrapezoid (STT) changes was variably described across
series. In most series, metacarpophalangeal hyperextension did not seem
to have an adverse effect on outcomes, although these patients were
excluded in some series.
Conclusions
Arthroscopic débridement with or without interposition can be used
for treatment of Eaton Stages I to III CMC osteoarthritis with
satisfactory outcomes. Some series suggest satisfactory outcomes in the
setting of STT changes and metacarpophalangeal hyperextension.
Abstract on SpringerLink
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