Novel Technique for Suture Suspension Arthroplasty of the Thumb Carpometacarpal Joint Using the Locking “Nice” Knot

Abstract

Osteoarthritis (OA) of the first carpometacarpal (CMC) joint is common and often presents as pain, weakness, or sense of instability in the joint. A common surgical technique for treatment is the suture suspension arthroplasty, which was first described in 2009 by DelSignore et al. with successful long term follow up reported in 2023. This technique involves piercing the flexor carpi radialis (FCR) tendon, which poses a risk of tendon rupture. Many adjustments to the original technique have been proposed, including modified suture patterns, suture buttons, and awake surgeries to avoid overtightening. The purpose of this paper is to discuss a novel modification to the original technique that eliminates the need to pierce the FCR tendon by utilizing the “Nice” knot. We believe this technique decreases rates of FCR rupture and also decreases surgical cost and time, which is important in today's value-based healthcare landscape. Follow-up is needed to determine if these claims are true. Next, we plan to conduct a retrospective chart review to determine if this new technique truly leads to lower rates of FCR tendon rupture, decreased operative time, and decreased patient costs.