Biomechanical evaluation of the first carpometacarpal joint stability by using different reconstruction methods_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HEShukun , XULong ^△ , ZHAOSichun ,  HUANGFuguo

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

HUANGFuguo, Email: huang-f-g@163.com

Keywords：

First carpometacarpal joint; tendon transposition; ligament reconstruction; biomechanics

DOI：

10.7507/1002-1892.201610035

Video：

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Objective To study the biomechanical differences of the first carpometacarpal joint stability by using different reconstruction methods so as to provide theoretical basis for the clinical choice of reconstruction method. Methods The upper limb specimens were selected from 12 fresh adult cadavers, which had no fracture, bone disease, dislocation of wrist joint, deformity, degeneration, or ligament injury on the anteroposterior and lateral X-ray films. The specimens were randomly divided into 5 groups: normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group. Three normal specimens were used as normal group, and then were made of the first carpometacarpal joint dislocation models (injury group); after the first carpometacarpal joint dislocation was established in the other 9 specimens; the volar ligament, dorsal ligament, and volar-dorsal ligaments were reconstructed with Eaton-Little method, Yin Weitian method, and the above two methods in 3 construction groups. The biomechanical test was done to obtain the load-displacement curve and to calculate the elastic modulus. Results During biomechanical test, ligament rupture and loosening of Kirschner wire occurred in 1 case of injury group and palmar carpometacarpal ligaments reconstruction group; no slipping was observed. The elastic modulus values were (11.61±0.20), (5.39±0.12), (6.33±0.10), (7.12±0.08), and (8.30±0.10) MPa in normal group, injury group, palmar carpometacarpal ligaments reconstruction group, dorsal carpometacarpal ligaments reconstruction group, and palmar and dorsal carpometacarpal ligaments reconstruction group respectively, showing significant differences among groups (P<0.05). Conclusion Volar ligament reconstruction, dorsal ligament reconstruction, and volar-dorsal ligament reconstruction all can greatly improve the stability of the first carpometacarpal joint. And the effect of volar-dorsal ligament reconstruction is the best, but the stability can not restore to normal.

Citation： HEShukun, XULong, ZHAOSichun, HUANGFuguo. Biomechanical evaluation of the first carpometacarpal joint stability by using different reconstruction methods. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 171-175. doi: 10.7507/1002-1892.201610035 Copy

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2.	Imaeda T, An KN, Cooney WP 3rd. Functional anatomy and biomechanics of the thumb. Hand Clin, 1992, 8(1): 9-15.
3.	Ladd AL, Crisco JJ, Hagert E,et al. The puzzle of the thumb: mobility, stability, and demands in opposition. Clin Orthop Relat Res, 2014, 472(12): 3605-3622.
4.	Lane LB, Henley DH. Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint. J Hand Surg (Am), 2001, 26(4): 686-691.
5.	Haines RW. The mechanism of rotation at the first carpo-metacarpal joint. J Anat, 1944, 78(Pt 1-2): 44-46.
6.	Bojsen-Møller F. Osteoligamentous guidance of the movements of the human thumb. Am J Anat, 1976, 147(1): 71-80.
7.	Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg (Am), 2008, 33(3): 438-441.
8.	Takwale VJ, Stanley JK, Shahane SA. Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament. J Bone Joint Surg (Am), 2004, 86(4): 541-545.
9.	贾万新, 侯明钟, 袁启智. 陈旧性第一腕掌关节半脱位的手术治疗. 中华手外科杂志, 1998, 14(3): 190-191.
10.	费起礼, 刘巨荣, 周强. 第一腕掌关节创伤性半脱位的韧带重建. 中华骨科杂志, 1996, 16(3): 194-195.
11.	Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg (Am), 1973, 55(8): 1655-1666.
12.	Iyengar K, Gandham S, Nadkarni J,et al. Modified Eaton-Littler’s reconstruction for traumatic dislocation of the carpometacarpal joint of the thumb—A case report and review of literature. J Hand Microsurg, 2013, 5(1): 36-42.
13.	Annappa R, Kotian P, P JA,et al. Ligamentous reconstruction of traumatic dislocation of thumb carpometacarpal joint: case report and review of literature. J Orthop Case Rep, 2015, 5(4): 79-81.
14.	卢世璧, 刘桂林, 王继芳. 陈旧性拇指腕掌关节脱位的手术治疗. 中华骨科杂志, 1996, 16(3): 193-194.
15.	Mody BS, Dias JJ. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. J Hand Surg (Br), 1993, 18(2): 197-199.
16.	Chen VT. Dislocation of the carpometacarpal joint of the thumb. J Hand Surg (Br), 1987, 12(2): 246-251.
17.	D'Agostino P, Kerkhof FD, Shahabpour M,et al. 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.
18.	于胜吉, 蔡锦方. 腕关节外科. 北京: 人民卫生出版社, 2002: 56-316.
19.	Edmunds JO. Current concepts of the anatomy of the thumb trapeziometacarpal joint. J Hand Surg (Am), 2011, 36(1): 170-182.
20.	Van Brenk B, Richards RR, Mackay MB,et al. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg (Am), 1998, 23(4): 607-611.
21.	Pagalidis T, Kuczynski K, Lamb DW. Ligamentous stability of the base of the thumb. Hand, 1981, 13(1): 29-36.
22.	Bettinger PC, Linscheid RL, Berger RA,et al. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg (Am), 1999, 24(4): 786-798.
23.	Sawalha S. Volar dislocation of the thumb carpometacarpal joint: A case report. Injury Extra, 2008, 39(10): 332-334.
24.	田青业, 刘正津, 周军海. 拇指腕掌关节韧带的力学特性及其意义. 中国临床解剖学杂志, 2002, 20(1): 68-70.
25.	Fotiadis E, Svarnas T, Lyrtzis C,et al. Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature. J Orthop Surg Res, 2010, 5(1): 1-5.
26.	Birman MV, Danoff JR, Yemul KS,et al. Dorsoradial ligament imbrication for thumb carpometacarpal joint instability. Tech Hand Up Extrem Surg, 2014, 18(2): 66-71.
27.	Lin JD, Karl JW, Strauch RJ. Trapeziometacarpal joint stability: the evolving importance of the dorsal ligaments. Clin Orthop Relat Res, 2014, 472(4): 1138-1145.
28.	Mody BS, Dias JJ. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. Journal of Orthopaedics and Traumatology, 2015, 21(2): 411-412.
29.	Blanco JF, Pescador D, Viñas A. A congenital dislocation of the trapeziometacarpal joint. J Hand Surg Eur Vol, 2011, 36(2): 160-161.
30.	Farivar L, Reza Z, Arash M. First carpometacarpal joint dislocation and review of literatures. Arch Bone Jt Surg, 2015, 3(4): 300-303.

1. Imaeda T, An KN, Cooney WP 3rd,et al. Anatomy of trapeziometacarpal ligaments. J Hand Surg (Am), 1993, 18(2): 226-231.
2. Imaeda T, An KN, Cooney WP 3rd. Functional anatomy and biomechanics of the thumb. Hand Clin, 1992, 8(1): 9-15.
3. Ladd AL, Crisco JJ, Hagert E,et al. The puzzle of the thumb: mobility, stability, and demands in opposition. Clin Orthop Relat Res, 2014, 472(12): 3605-3622.
4. Lane LB, Henley DH. Ligament reconstruction of the painful, unstable, nonarthritic thumb carpometacarpal joint. J Hand Surg (Am), 2001, 26(4): 686-691.
5. Haines RW. The mechanism of rotation at the first carpo-metacarpal joint. J Anat, 1944, 78(Pt 1-2): 44-46.
6. Bojsen-Møller F. Osteoligamentous guidance of the movements of the human thumb. Am J Anat, 1976, 147(1): 71-80.
7. Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg (Am), 2008, 33(3): 438-441.
8. Takwale VJ, Stanley JK, Shahane SA. Post-traumatic instability of the trapeziometacarpal joint of the thumb. Diagnosis and the results of reconstruction of the beak ligament. J Bone Joint Surg (Am), 2004, 86(4): 541-545.
9. 贾万新, 侯明钟, 袁启智. 陈旧性第一腕掌关节半脱位的手术治疗. 中华手外科杂志, 1998, 14(3): 190-191.
10. 费起礼, 刘巨荣, 周强. 第一腕掌关节创伤性半脱位的韧带重建. 中华骨科杂志, 1996, 16(3): 194-195.
11. Eaton RG, Littler JW. Ligament reconstruction for the painful thumb carpometacarpal joint. J Bone Joint Surg (Am), 1973, 55(8): 1655-1666.
12. Iyengar K, Gandham S, Nadkarni J,et al. Modified Eaton-Littler’s reconstruction for traumatic dislocation of the carpometacarpal joint of the thumb—A case report and review of literature. J Hand Microsurg, 2013, 5(1): 36-42.
13. Annappa R, Kotian P, P JA,et al. Ligamentous reconstruction of traumatic dislocation of thumb carpometacarpal joint: case report and review of literature. J Orthop Case Rep, 2015, 5(4): 79-81.
14. 卢世璧, 刘桂林, 王继芳. 陈旧性拇指腕掌关节脱位的手术治疗. 中华骨科杂志, 1996, 16(3): 193-194.
15. Mody BS, Dias JJ. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. J Hand Surg (Br), 1993, 18(2): 197-199.
16. Chen VT. Dislocation of the carpometacarpal joint of the thumb. J Hand Surg (Br), 1987, 12(2): 246-251.
17. D'Agostino P, Kerkhof FD, Shahabpour M,et al. 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.
18. 于胜吉, 蔡锦方. 腕关节外科. 北京: 人民卫生出版社, 2002: 56-316.
19. Edmunds JO. Current concepts of the anatomy of the thumb trapeziometacarpal joint. J Hand Surg (Am), 2011, 36(1): 170-182.
20. Van Brenk B, Richards RR, Mackay MB,et al. A biomechanical assessment of ligaments preventing dorsoradial subluxation of the trapeziometacarpal joint. J Hand Surg (Am), 1998, 23(4): 607-611.
21. Pagalidis T, Kuczynski K, Lamb DW. Ligamentous stability of the base of the thumb. Hand, 1981, 13(1): 29-36.
22. Bettinger PC, Linscheid RL, Berger RA,et al. An anatomic study of the stabilizing ligaments of the trapezium and trapeziometacarpal joint. J Hand Surg (Am), 1999, 24(4): 786-798.
23. Sawalha S. Volar dislocation of the thumb carpometacarpal joint: A case report. Injury Extra, 2008, 39(10): 332-334.
24. 田青业, 刘正津, 周军海. 拇指腕掌关节韧带的力学特性及其意义. 中国临床解剖学杂志, 2002, 20(1): 68-70.
25. Fotiadis E, Svarnas T, Lyrtzis C,et al. Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature. J Orthop Surg Res, 2010, 5(1): 1-5.
26. Birman MV, Danoff JR, Yemul KS,et al. Dorsoradial ligament imbrication for thumb carpometacarpal joint instability. Tech Hand Up Extrem Surg, 2014, 18(2): 66-71.
27. Lin JD, Karl JW, Strauch RJ. Trapeziometacarpal joint stability: the evolving importance of the dorsal ligaments. Clin Orthop Relat Res, 2014, 472(4): 1138-1145.
28. Mody BS, Dias JJ. Carpometacarpal dislocation of the thumb associated with fracture of the trapezium. Journal of Orthopaedics and Traumatology, 2015, 21(2): 411-412.
29. Blanco JF, Pescador D, Viñas A. A congenital dislocation of the trapeziometacarpal joint. J Hand Surg Eur Vol, 2011, 36(2): 160-161.
30. Farivar L, Reza Z, Arash M. First carpometacarpal joint dislocation and review of literatures. Arch Bone Jt Surg, 2015, 3(4): 300-303.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical evaluation of the first carpometacarpal joint stability by using different reconstruction methods

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