Knotless Suture Anchor Suspensionplasty for Basal Joint Arthritis: A Prospective Case Series with Short-Term Outcomes

The simplest way to maintain the post-trapeziectomy space is through the use of hematoma distraction arthroplasty (HDA), which uses temporary Kirschner wires (K-wires) to hold the first metacarpal out to length relative to the second, allowing time for the space to fill with hematoma and scar tissue.6 Hematoma distraction arthroplasty is effective at prevention of subsidence; however, patients report pain and irritation from the K-wires and the pin fixation limits early mobilization of the thumb.7-10 Ligamentous reconstruction and tendon interposition (LRTI) applies to techniques that involve using autologous tendons, usually the palmaris longus, flexor carpi radialis (FCR), abductor pollicis longus (APL), or extensor carpi radialis longus, to create a suspensory effect on the first metacarpal while also creating a space filling interposition graft for the post-trapeziectomy space.6 Although trapeziectomy with LRTI provides long-term pain relief and excellent functionality, an increased risk of complications due to increased operative time, case complexity, and dissection for graft harvesting has been reported, and a significant period of immobilization is required for soft tissue healing to occur.11 Additionally, studies have failed to show a benefit over trapeziectomy alone.11-13 Despite this evidence, in a 2012 poll of American Society for Surgery of the Hand members, 62% identified that trapeziectomy with LRTI was their operation of choice for treating basal joint arthritis.14 Trapezial space prostheses have been used, and limited long-term success has been reported. No high-level evidence has ever been produced to show that any implant is superior to other procedures, and these implants are associated with complications such as loosening, dislocation or subluxation, and foreign body reactions.6'10'12'15 In 2009, DelSignore and Accardi16 introduced the concept of suspensionplasty using non-absorbable suture to create a suspension sling between the FCR and APL. Studies have found that suture suspensionplasty is time effective, inexpensive, and provides good outcomes; however, again it has not been proven to be superior to trapeziectomy alone and requires immobilization until soft tissue healing occurs.6-17-18 Recently, suture-button technology has been incorporated into a suspensionplasty technique with the goal of eliminating the need for immobilization during soft tissue healing and, therefore, allowing for early mobilization.8'9 In theory, early mobi