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Macroscopic and Microscopic Analysis of the Thumb Carpometacarpal Ligaments: A Cadaveric Study of Ligament Anatomy and Histology

Ladd, Amy L. MD; Lee, Julia MD; Hagert, Elisabet MD, PhD

Journal of Bone & Joint Surgery - American Volume: 15 August 2012 - Volume 94 - Issue 16 - p 1468–1477
doi: 10.2106/JBJS.K.00329
Scientific Articles

Background: Stability and mobility represent the paradoxical demands of the human thumb carpometacarpal joint, yet the structural origin of each functional demand is poorly defined. As many as sixteen and as few as four ligaments have been described as primary stabilizers, but controversy exists as to which ligaments are most important. We hypothesized that a comparative macroscopic and microscopic analysis of the ligaments of the thumb carpometacarpal joint would further define their role in joint stability.

Methods: Thirty cadaveric hands (ten fresh-frozen and twenty embalmed) from nineteen cadavers (eight female and eleven male; average age at the time of death, seventy-six years) were dissected, and the supporting ligaments of the thumb carpometacarpal joint were identified. Ligament width, length, and thickness were recorded for morphometric analysis and were compared with use of the Student t test. The dorsal and volar ligaments were excised from the fresh-frozen specimens and were stained with use of a triple-staining immunofluorescent technique and underwent semiquantitative analysis of sensory innervation; half of these specimens were additionally analyzed for histomorphometric data. Mixed-effects linear regression was used to estimate differences between ligaments.

Results: Seven principal ligaments of the thumb carpometacarpal joint were identified: three dorsal deltoid-shaped ligaments (dorsal radial, dorsal central, posterior oblique), two volar ligaments (anterior oblique and ulnar collateral), and two ulnar ligaments (dorsal trapeziometacarpal and intermetacarpal). The dorsal ligaments were significantly thicker (p < 0.001) than the volar ligaments, with a significantly greater cellularity and greater sensory innervation compared with the anterior oblique ligament (p < 0.001). The anterior oblique ligament was consistently a thin structure with a histologic appearance of capsular tissue with low cellularity.

Conclusions: The dorsal deltoid ligament complex is uniformly stout and robust; this ligament complex is the thickest morphometrically, has the highest cellularity histologically, and shows the greatest degree of sensory nerve endings. The hypocellular anterior oblique ligament is thin, is variable in its location, and is more structurally consistent with a capsular structure than a proper ligament.

Clinical Relevance: Delineation of the structural and microscopic anatomy of the ligaments of the thumb carpometacarpal joint provides further evidence regarding the stability and mobility of this joint that is often affected by osteoarthritis.

1Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University, 770 Welch Road, Suite 400, Stanford, CA 94304. E-mail address for A.L. Ladd: alad@stanford.edu

Copyright 2012 by The Journal of Bone and Joint Surgery, Incorporated
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