Novel Technique for Suture Suspension Arthroplasty of the Thumb 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 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. In addition, this technique tunnels suture through the base of the first CMC, pierces the distal abductor pollicis longus (APL) and finally ties remaining suture together, eliminating the need for a suture anchor. We believe these changes lead to lower rates of FCR tendon rupture, improved suspensionoplasty stability, and decreased time and cost of procedure, thus maximizing value-based care.