Download PDF
J Wrist Surg 2013; 02(01): 055-062
DOI: 10.1055/s-0033-1333683
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Thumb Carpometacarpal Ligaments Inside and Out: A Comparative Study of Arthroscopic and Gross Anatomy from the Robert A. Chase Hand and Upper Limb Center at Stanford University

Andrew Y. Zhang
1   Stanford, University, Palo Alto, California
,
Sarah Van Nortwick
1   Stanford, University, Palo Alto, California
,
Elisabet Hagert
1   Stanford, University, Palo Alto, California
2   Karolinska Institutet, Solna, Sweden
,
Amy L. Ladd
1   Stanford, University, Palo Alto, California
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2013 (online)

    Permissions and Reprints

Corrected by:

Thumb Carpometacarpal Ligaments Inside and Out: A Comparative Study of Arthroscopic and Gross Anatomy from the Robert A. Chase Hand and Upper Limb Center at Stanford UniversityJ Wrist Surg 2014; 03(04): e1-e1
DOI: 10.1055/s-0033-1338108

Abstract

Purpose We propose to identify and correlate arthroscopic internal ligaments with external ligaments, providing an accurate roadmap for arthroscopic ligament and joint anatomy. Ligamentous laxity is considered an important risk factor in developing the common basilar arthritis of the thumb. Controversy exists as to the precise ligamentous anatomy of the thumb carpometacarpal (CMC) joint (CMC-I); description of the internal arthroscopic anatomy is limited.

Methods We performed CMC-I joint arthroscopy using the 1-Ulnar (1U) and thenar portals in five cadavers, seeking to identify the following seven ligaments arthroscopically: the superficial anterior oblique ligament (sAOL), deep anterior oblique ligament (dAOL), ulnar collateral ligament (UCL), dorsal trapeziometacarpal ligament (DTM-1), posterior oblique ligament (POL), dorsal central ligament (DCL), and dorsal radial ligament (DRL). After grading articular changes of the trapezium, we passed Kirschner wires (K-wires) (0.028) outside-in to mark the arthroscopic insertion of each ligament on the trapezium. Gross dissection was performed to confirm the wire placement; the anatomic identity and position of joint stabilizing ligaments, and the location of frequently used portals.

Results The volar ligaments—the sAOL, dAOL, and UCL—were highly variable in their arthroscopic appearance and precise location. The sAOL is a thin veil of membranous tissue that variably drapes across the anterior joint capsule. The reported dAOL and UCL, in our study, correlated to a thickened portion of this veil around the volar beak and was not consistently identified with gross dissection. In contrast, the arthroscopic appearance and location of the dorsal ligaments—DTM-I, POL, DCL, and DRL—were consistent in all specimens.

Conclusion Our study further defines and correlates the arthroscopic and external ligamentous anatomy of the CMC-I joint.

Keywords

arthroscopy - gross anatomy - ligament anatomy - thumb CMC - arthroscopy - thumb CMC arthritis
 

  • References

  • 1 Haara MM, Heliövaara M, Kröger H , et al. Osteoarthritis in the carpometacarpal joint of the thumb. Prevalence and associations with disability and mortality. J Bone Joint Surg Am 2004; 86–A (7) 1452-1457
    PubMedGoogle Scholar
  • 2 Wilder FV, Barrett JP, Farina EJ. Joint-specific prevalence of osteoarthritis of the hand. Osteoarthritis Cartilage 2006; 14 (9) 953-957
    Google Scholar
  • 3 Burton RI, Pellegrini Jr VD. Surgical management of basal joint arthritis of the thumb. Part II. Ligament reconstruction with tendon interposition arthroplasty. J Hand Surg Am 1986; 11 (3) 324-332
    CrossrefPubMedGoogle Scholar
  • 4 Eaton RG, Lane LB, Littler JW, Keyser JJ. Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment. J Hand Surg Am 1984; 9 (5) 692-699
    CrossrefPubMedGoogle Scholar
  • 5 Varley GW, Calvey J, Hunter JB, Barton NJ, Davis TR. Excision of the trapezium for osteoarthritis at the base of the thumb. J Bone Joint Surg Br 1994; 76 (6) 964-968
    PubMedGoogle Scholar
  • 6 Badia A. Trapeziometacarpal arthroscopy: a classification and treatment algorithm. Hand Clin 2006; 22 (2) 153-163
    CrossrefPubMedGoogle Scholar
  • 7 Berger RA. A technique for arthroscopic evaluation of the first carpometacarpal joint. J Hand Surg Am 1997; 22 (6) 1077-1080
    CrossrefPubMedGoogle Scholar
  • 8 Culp RW, Rekant MS. The role of arthroscopy in evaluating and treating trapeziometacarpal disease. Hand Clin 2001; 17 (2) 315-319 , x–xi
    PubMedGoogle Scholar
  • 9 Menon J. Arthroscopic management of trapeziometacarpal joint arthritis of the thumb. Arthroscopy 1996; 12 (5) 581-587
    CrossrefPubMedGoogle Scholar
  • 10 Bettinger PC, Linscheid RL, Berger RA, Cooney III WP, An KN. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am 1999; 24 (4) 786-798
    CrossrefPubMedGoogle Scholar
  • 11 Van Brenk B, Richards RR, Mackay MB, Boynton EL. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg Am 1998; 23 (4) 607-611
    CrossrefPubMedGoogle Scholar
  • 12 Zancolli EA, Cozzi EP. The trapeziometacarpal joint: anatomy and mechanics. In: Zancolli E, Cozzi EP, , ed. Atlas of Surgical Anatomy of the Hand. New York: Churchill Livingstone; 1992: 432-444
    Google Scholar
  • 13 Pellegrini Jr VD. Pathomechanics of the thumb trapeziometacarpal joint. Hand Clin 2001; 17 (2) 175-184 , vii–viii
    PubMedGoogle Scholar
  • 14 Bettinger PC, Berger RA. Functional ligamentous anatomy of the trapezium and trapeziometacarpal joint (gross and arthroscopic). Hand Clin 2001; 17 (2) 151-168 , vii
    PubMedGoogle Scholar
  • 15 Orellana MA, Chow JCY. Arthroscopic visualization of the thumb carpometacarpal joint: introduction and evaluation of a new radial portal. Arthroscopy 2003; 19 (6) 583-591
    CrossrefPubMedGoogle Scholar
  • 16 Walsh EF, Akelman E, Fleming BC, DaSilva MF. Thumb carpometacarpal arthroscopy: a topographic, anatomic study of the thenar portal. J Hand Surg Am 2005; 30 (2) 373-379
    CrossrefPubMedGoogle Scholar
  • 17 Pellegrini Jr VD. Osteoarthritis of the trapeziometacarpal joint: the pathophysiology of articular cartilage degeneration. I. Anatomy and pathology of the aging joint. J Hand Surg Am 1991; 16 (6) 967-974
    CrossrefPubMedGoogle Scholar
  • 18 Lee J, Ladd AL, Hagert E. Immunofluorescent triple-staining technique to identify sensory nerve endings in human thumb ligaments. Cells Tissues Organs 2012; 195 (5) 456-464
    CrossrefPubMedGoogle Scholar
  • 19 Ladd AL, Lee J, Hagert E. Anatomy, histology and histomorphometric analysis of the thumb carpometacarpal ligaments. J Bone Joint Surg [Am] 2012; Aut 15; 94 (16) 1468-77
    CrossrefPubMedGoogle Scholar
  • 20 Slutsky DJ. The use of a dorsal-distal portal in trapeziometacarpal arthroscopy. Arthroscopy 2007; 23 (11) e1-e4
    PubMedGoogle Scholar
  • 21 Xu L, Strauch RJ, Ateshian GA, Pawluk RJ, Mow VC, Rosenwasser MP. Topography of the osteoarthritic thumb carpometacarpal joint and its variations with regard to gender, age, site, and osteoarthritic stage. J Hand Surg Am 1998; 23 (3) 454-464
    CrossrefPubMedGoogle Scholar
  • 22 Outerbridge RE. The etiology of chondromalacia patellae. J Bone Joint Surg Br 1961; 43–B: 752-757
    PubMedGoogle Scholar
  • 23 Berger RA. The anatomy of the ligaments of the wrist and distal radioulnar joints. Clin Orthop Relat Res 2001; 383 (383) 32-40
    CrossrefPubMedGoogle Scholar
  • 24 Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin 1997; 13 (1) 63-82
    PubMedGoogle Scholar
  • 25 Badia A. Arthroscopic indications and technique for Artelon interposition arthroplasty of the thumb trapeziometacarpal joint. Tech Hand Up Extrem Surg 2008; 12 (4) 236-241
    CrossrefPubMedGoogle Scholar
  • 26 Earp BE, Leung AC, Blazar PE, Simmons BP. Arthroscopic hemitrapeziectomy with tendon interposition for arthritis at the first carpometacarpal joint. Tech Hand Up Extrem Surg 2008; 12 (1) 38-42
    CrossrefPubMedGoogle Scholar
  • 27 Imaeda T, An KN, Cooney III WP, Linscheid R. Anatomy of trapeziometacarpal ligaments. J Hand Surg Am 1993; 18 (2) 226-231
    CrossrefPubMedGoogle Scholar
  • 28 Kauer JM. Functional anatomy of the carpometacarpal joint of the thumb. Clin Orthop Relat Res 1987; 220 (220) 7-13
    PubMedGoogle Scholar
  • 29 Najima H, Oberlin C, Alnot JY, Cadot B. Anatomical and biomechanical studies of the pathogenesis of trapeziometacarpal degenerative arthritis. J Hand Surg [Br] 1997; 22 (2) 183-188
    PubMedGoogle Scholar
  • 30 Tan J, Xu J, Xie RG, Deng AD, Tang JB. In vivo length and changes of ligaments stabilizing the thumb carpometacarpal joint. J Hand Surg Am 2011; 36 (3) 420-427
    CrossrefPubMedGoogle Scholar
  • 31 Nanno M, Buford Jr WL, Patterson RM, Andersen CR, Viegas SF. Three-dimensional analysis of the ligamentous attachments of the first carpometacarpal joint. J Hand Surg Am 2006; 31 (7) 1160-1170
    CrossrefPubMedGoogle Scholar
  • 32 Neumann DA, Bielefeld T. The carpometacarpal joint of the thumb: stability, deformity, and therapeutic intervention. J Orthop Sports Phys Ther 2003; 33 (7) 386-399
    CrossrefPubMedGoogle Scholar