Download PDF
J Wrist Surg 2016; 05(04): 277-283
DOI: 10.1055/s-0036-1581052
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy

Mireia Esplugas
1   Clinica Activamutua, Tarragona, Spain
,
Alex Lluch-Bergada
2   Institut Kaplan, Barcelona, Spain
,
Nathalie Mobargha
3   Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden
4   Department of Hand and Plastic Surgery, Stavanger University Hospital, Stavanger, Norway
,
Manuel Llusa-Perez
5   Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
,
Elisabet Hagert
3   Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden
6   Hand and Foot Surgery Center, Stockholm, Sweden
,
Marc Garcia-Elias
2   Institut Kaplan, Barcelona, Spain
› Author Affiliations
Further Information

Publication History

27 December 2015

16 February 2016

Publication Date:
29 March 2016 (online)

    Permissions and Reprints

Abstract

Purpose In the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ.

Methods Overall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a paired t-test, with a significance level of p < 0.05.

Results After isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512; p = 0.004).

Conclusion Sectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers.

Clinical Relevance This study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.

Keywords

TMJ instability - TMJ biomechanics - TMJ ligaments - TMJ arthroscopy - thumb arthroscopy
 

  • References

  • 1 Pellegrini Jr VD. Pathomechanics of the thumb trapeziometacarpal joint. Hand Clin 2001; 17 (2) 175-184 , vii–viii
    PubMedGoogle Scholar
  • 2 Armstrong AL, Hunter JB, Davis TR. The prevalence of degenerative arthritis of the base of the thumb in post-menopausal women. J Hand Surg [Br] 1994; 19 (3) 340-341
    CrossrefPubMedGoogle Scholar
  • 3 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
  • 4 Pellegrini Jr VD, Olcott CW, Hollenberg G. Contact patterns in the trapeziometacarpal joint: the role of the palmar beak ligament. J Hand Surg Am 1993; 18 (2) 238-244
    CrossrefPubMedGoogle Scholar
  • 5 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
  • 6 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
  • 7 Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg Am 1973; 55 (8) 1655-1666
    CrossrefPubMedGoogle Scholar
  • 8 Bettinger PC, Linscheid RL, Berger RA, Cooney III WP, An K-N. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg Am 1999; 24 (4) 786-798
    CrossrefPubMedGoogle Scholar
  • 9 Bettinger PC, Smutz WP, Linscheid RL, Cooney III WP, An KN. Material properties of the trapezial and trapeziometacarpal ligaments. J Hand Surg Am 2000; 25 (6) 1085-1095
    CrossrefPubMedGoogle Scholar
  • 10 Ladd AL, Lee J, Hagert E. Macroscopic and microscopic analysis of the thumb carpometacarpal ligaments: a cadaveric study of ligament anatomy and histology. J Bone Joint Surg Am 2012; 94 (16) 1468-1477
    CrossrefPubMedGoogle Scholar
  • 11 D'Agostino P, Kerkhof FD, Shahabpour M, Moermans JP, Stockmans F, Vereecke EE. Comparison of the anatomical dimensions and mechanical properties of the dorsoradial and anterior oblique ligaments of the trapeziometacarpal joint. J Hand Surg Am 2014; 39 (6) 1098-1107
    CrossrefPubMedGoogle Scholar
  • 12 Hagert E, Lee J, Ladd AL. Innervation patterns of thumb trapeziometacarpal joint ligaments. J Hand Surg Am 2012; 37 (4) 706-714.e1
    CrossrefPubMedGoogle Scholar
  • 13 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
  • 14 Kobayashi M, Garcia-Elias M, Nagy L , et al. Axial loading induces rotation of the proximal carpal row bones around unique screw-displacement axes. J Biomech 1997; 30 (11–12) 1165-1167
    CrossrefPubMedGoogle Scholar
  • 15 Salvà-Coll G, García-Elias M, León-Lopez MT, Llusá-Perez M, Rodríguez-Baeza A. Effects of forearm muscles on carpal stability. J Hand Surg Eur Vol 2011; 36 (7) 553-559
    CrossrefPubMedGoogle Scholar
  • 16 Mobargha N, Esplugas M, Garcia-Elias M, Lluch A, Megerle K, Hagert E. The effect of individual isometric muscle loading on the alignment of the base of the thumb metacarpal: a cadaveric study. J Hand Surg Eur Vol 2015; (e-pub ahead of print). doi: 10.1177/1753193415597114
    PubMedGoogle Scholar
  • 17 Rayan G, Do V. Dorsoradial capsulodesis for trapeziometacarpal joint instability. J Hand Surg Am 2013; 38 (2) 382-387
    CrossrefPubMedGoogle Scholar
  • 18 Badia A. Trapeziometacarpal arthroscopy: a classification and treatment algorithm. Hand Clin 2006; 22 (2) 153-163
    CrossrefPubMedGoogle Scholar
  • 19 Chu PJ, Lee HM, Chung LJ, Shih JT. Electrothermal treatment of thumb basal joint instability. Arthroscopy 2009; 25 (3) 290-295
    CrossrefPubMedGoogle Scholar
  • 20 Zhang AY, Van Nortwick S, Hagert E, Yao J, Ladd AL. 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. J Wrist Surg 2013; 2 (1) 55-62
    PubMedGoogle Scholar
  • 21 Menon J. Arthroscopic management of trapeziometacarpal joint arthritis of the thumb. Arthroscopy 1996; 12 (5) 581-587
    CrossrefPubMedGoogle Scholar
  • 22 Lindau TR, Mathew P. Radial artery pseudoaneurysm in TMC arthroscopy: a case report, a cadaveric study and a systematic review of the literature regarding complications. MOJ Orthop Reumatol 2015; 2 (6) 00075 . doi: 10.15406/mojor.2015.02.00075
    PubMedGoogle Scholar
  • 23 Orellana MA, Chow JC. Arthroscopic visualization of the thumb carpometacarpal joint: introduction and evaluation of a new radial portal. Arthroscopy 2003; 19 (6) 583-591
    CrossrefPubMedGoogle Scholar
  • 24 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
  • 25 Slutsky DJ. The use of a dorsal-distal portal in trapeziometacarpal arthroscopy. Arthroscopy 2007; 23 (11) 1244.e1-1244.e4
    CrossrefPubMedGoogle Scholar
  • 26 Ludwig CA, Mobargha N, Okogbaa J, Hagert E, Ladd AL. Altered innervation pattern in ligaments of patients with basal thumb arthritis. J Wrist Surg 2015; 4 (4) 284-291
    PubMedGoogle Scholar