Comparison of Postoperative Outcomes of Surgical Techniques in Basilar Thumb Reconstruction: Trapeziectomy with FiberLock InternalBrace Reconstruction and Tenodesis versus Ligament Reconstruction and Tendon Interposition.

Abstract

HYPOTHESIS: FiberLock suture suspenionplasty will yield superior post-operative outcomes at both 6 weeks and 6 months following BTR in terms of patient-reported outcome measures (PROMIS), functional disability (QuickDASH), pain levels (painVAS), and surgery satisfaction compared to trapeziectomy with ligament reconstruction and tendon interposition (LTRI) in patients with thumb CMC joint osteoarthritis. METHODS: Retrospective data was collected on patients with thumb carpometacarpal (CMC) arthritis who underwent trapeziectomy and either LRTI or Arthrex FiberLockTM Suspension Implants (Arthrex, Naples, FL, USA) InternalBrace suspensionplasty with side-to-side flexor carpi radialis tendon transfer. Outcomes were measured using the Visual Analogue Scale (VAS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire, and Patient-Reported Outcomes Measurement Information System (PROMIS) v1.2 Upper Extremity (UE) item bank. Patient reports of surgery satisfaction and demographic data were recorded. Patients without completed questionnaires were excluded from analysis. At 6 weeks there were 74 LRTI and 74 FiberLock patients, while at 6 months, 65 patients remained in each group. Multiple Imputation by Chained Equations was utilized for missing data fields within surveys. Wilcoxon Rank Sum Test with Bonferroni correction were utilized to compare outcome scores of each group at 6-weeks and 6-months. RESULTS: No significant (all p > 0.05) differences between groups for any outcome (VAS Pain 24 Hours, VAS Pain When Resting, VAS Pain When Active, PROMIS Upper Extremity, Quick DASH, and surgery satisfaction). SUMMARY: The surgical techniques provide similar outcomes in pain, function, and patient satisfaction at both short-term (6 weeks) and medium-term (6 months) follow-ups, suggesting that the newer FiberLock procedure may yield comparable patient outcomes to the standard LRTI. Our study is limited by incomplete survey data, as some patients either skipped questions or missed surveys entirely, which was addressed by employing multiple imputation and pooling techniques before analysis. Further research involving larger cohorts and extended follow-up periods is necessary to enhance our understanding of the potential advantages of FiberLock suspensionplasty versus LRTI in managing basilar thumb arthritis.