TechniquesSuture Suspension Arthroplasty With Trapeziectomy for Thumb Carpometacarpal Arthritis Using a Wide-awake ApproachTakagi, Takehiko MD, PhD*; Weiss, Arnold-Peter C. MD†Author Information *Department of Surgical Specialties, Division of Orthopaedic Surgery, National Center for Child Health and Development, Tokyo, Japan †Department of Orthopaedics, Alpert Medical School of Brown University, Providence, RI The authors do not receive for this work from any of the following organizations: National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s). Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding. Address correspondence and reprint requests to Takehiko Takagi, MD, PhD, 2-10-1 Okura, Setagaya-ku, Tokyo 157-8535, Japan. E-mail: [email protected]. Techniques in Hand & Upper Extremity Surgery: June 2020 - Volume 24 - Issue 2 - p 66-70 doi: 10.1097/BTH.0000000000000265 Buy SDC Metrics Abstract Despite the introduction of various techniques for ligament reconstruction in the treatment of thumb carpometacarpal (CMC) arthritis, complications, including proximal migration, dorsal subluxation of the first metacarpal base, hyperextension of the thumb metacarpophalangeal joint, and impingement between the first and second metacarpal bases, have been reported. Even suture button suspensionplasty with Arthrex Mini TightRope may be unable to correct the adduction contracture deformity and does not effectively tether the trapeziometacarpal toward the base of the index metacarpal, thus potentially leaving patients with persistent decreased first web space angle, proximal migration, and collapse deformity. Hence, suture suspension arthroplasty with abductor pollicis longus (APL)-flexor carpi radialis (FCR) tendon suture after trapeziectomy, a simpler technique, was applied. This simple surgical reconstruction abducts the first metacarpal bone. Abduction of the CMC joint improves metacarpophalangeal joint hyperextension. However, strong tension of the APL-FCR causes abduction contracture of the first CMC joint and difficulty of pinch motion of the thumb to the other fingers. Therefore, we have modified the arthroplasty with a wide-awake approach. The procedure is performed with the patient fully awake under local anesthesia, without a tourniquet to allow the patient to actively move and pinch the thumb, which allows the surgeon to confirm the tension of the APL-FCR suture. A fiber wire is connected to the APL-FCR with proper tension. The patient and surgeon can ensure pinch motion and thumb opposition with satisfaction during surgery. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.