Assessment of Dorsal Subluxation in Thumb Carpometacarpal Osteoarthritis

Abstract

Background Although dorsal subluxation is a typical finding for osteoarthritis of the thumb carpometacarpal (CMC) joint, it is difficult to evaluate the subluxation after trapeziectomy and the significance of its surgical correction combined with trapeziectomy is still controversial. The purpose of this study was to develop a method to evaluate dorsal subluxation without using landmarks on the trapezium.

Methods Thirty patients with thumb CMC arthritis and 13 normal patients were included in this study. Dorsal subluxation of the CMC joint was evaluated by measuring the distance between the volar tip of the thumb metacarpal base and dorsoradial border of the index metacarpal base (M1M2 overlap) on the X-ray true lateral view of the thumb as well as previously reported methods. Intraclass correlation coefficient (ICC) was used to assess inter- and intraobserver reliability for the measurement of M1M2 overlap by six examiners of different level of expertise. Dorsal subluxation was also evaluated after trapeziectomy with ligament reconstruction.

Results There were almost perfect interobserver (ICC = 0.94) and intraobserver (ICC = 0.95 for an expert and 0.97 for a novice) reliabilities for the measurement of M1M2 overlap. There was a weak correlation between our method and previously reported methods. M1M2 overlap of the normal patients and the patients were 4.6 ± 1.2 mm and 2.3 ± 2.3 mm (mean ± SD), respectively. M1M2 overlap was corrected significantly after trapeziectomy with ligament reconstruction.

Conclusion Dorsal subluxation of the thumb CMC joint could be evaluated by M1M2 overlap before and after trapeziectomy.

Keywords

thumb carpometacarpal joint - osteoarthritis - dorsal subluxation - trapeziectomy - ligament reconstruction

• References

• 1 Miura T, Ohe T, Masuko T. Comparative in vivo kinematic analysis of normal and osteoarthritic trapeziometacarpal joints. J Hand Surg Am 2004; 29 (02) 252-257
• 2 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 (05) 692-699
• 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 (03) 324-332
• 4 Wolf JM, Delaronde S. Current trends in nonoperative and operative treatment of trapeziometacarpal osteoarthritis: a survey of US hand surgeons. J Hand Surg Am 2012; 37 (01) 77-82
• 5 Trumble T, Rafijah G, Heaton D. Thumb carpometacarpal arthroplasty with ligament reconstruction and interposition costochondral arthroplasty. J Wrist Surg 2013; 2 (03) 220-227
• 6 Reissner L, Marks M, Schindele S, Herren DB. Comparison of clinical outcome with radiological findings after trapeziectomy with ligament reconstruction and tendon interposition. J Hand Surg Eur Vol 2016; 41 (03) 335-339
• 7 Kurosawa K, Tsuchiya I, Takagishi K. Trapezial-metacarpal joint arthritis: radiographic correlation between first metacarpal articular tilt and dorsal subluxation. J Hand Surg Am 2013; 38 (02) 302-308
• 8 Trumble TE, Rafijah G, Gilbert M, Allan CH, North E, McCallister WV. Thumb trapeziometacarpal joint arthritis: partial trapeziectomy with ligament reconstruction and interposition costochondral allograft. J Hand Surg Am 2000; 25 (01) 61-76
• 9 Kapandji A. Clinical opposition and reposition test of the thumb. Chir Main 1986; 5: 67-73
• 10 Field J, Buchanan D. To suspend or not to suspend: a randomised single blind trial of simple trapeziectomy versus trapeziectomy and flexor carpi radialis suspension. J Hand Surg Eur Vol 2007; 32 (04) 462-466
• 11 Gangopadhyay S, McKenna H, Burke FD, Davis TRC. Five- to 18-year follow-up for treatment of trapeziometacarpal osteoarthritis: a prospective comparison of excision, tendon interposition, and ligament reconstruction and tendon interposition. J Hand Surg Am 2012; 37 (03) 411-417
• 12 De Smet L, Sioen W, Spaepen D, van Ransbeeck H. Treatment of basal joint arthritis of the thumb: trapeziectomy with or without tendon interposition/ligament reconstruction. Hand Surg 2004; 9 (01) 5-9
• 13 Li YK, White C, Ignacy TA, Thoma A. Comparison of trapeziectomy and trapeziectomy with ligament reconstruction and tendon interposition: a systematic literature review. Plast Reconstr Surg 2011; 128 (01) 199-207
• 14 Nikkhah D, Rodrigues J, Saleh DB, Jeffers R. Can we really say that no patients benefit from ligament reconstruction tendon interposition?. Plast Reconstr Surg 2012; 129 (03) 557e-558e
• 15 Ladd AL, Messana JM, Berger AJ, Weiss AP. Correlation of clinical disease severity to radiographic thumb osteoarthritis index. J Hand Surg Am 2015; 40 (03) 474-482
• 16 Hoffler II CE, Matzon JL, Lutsky KF, Kim N, Beredjiklian PK. Radiographic stage does not correlate with symptom severity in thumb basilar joint osteoarthritis. J Am Acad Orthop Surg 2015; 23 (12) 778-782