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

Publication History

27 December 2015

16 February 2016

Publication Date:
29 March 2016 (eFirst)

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.