Efficacy of Dorsoradial Capsulodesis for Trapeziometacarpal Joint Instability: A Cadaver Study

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• 作者：Brian A. Chenoweth ; MD^&lowast ; ; Gavin D. O'Mahony ; MD^&lowast ; ; Casey Fitzgerald ; BS^&dagger ; ; Julie A. Stoner ; PhD^&Dagger ; ; Daniel L. O'Donoghue ; PhD^§ ; ; Ghazi M. Rayan ; MD^‖ ; ^{Lora.Nall@IntegrisOK.com}
• 关键词：Dorsoradial capsulodesis ; joint instability ; trapeziometacarpal joint
• 刊名：The Journal of Hand Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：42
• 期：1
• 页码：e25-e31
• 全文大小：1264 K
• 卷排序：42

文摘

To test the biomechanical properties of the dorsoradial capsulodesis procedure.MethodsSix cadaveric hands were used. After exposing the trapeziometacarpal (TMC) joint, we placed Kirschner wires in the distal radius and thumb metacarpal. The rotation shear test was then performed to test the joint axial laxity, and angular measurements using Kirschner wires as reference points were documented. The dorsoradial (DR) ligament and capsule were released, followed by the intermetacarpal (IM) ligament; angular measurements were obtained. Finally, the DR capsulodesis procedure was performed, and final measurements were obtained. Comparisons were made among the various stages of ligament integrity to determine the amount of stability provided by DR capsulodesis.ResultsAll cadavers demonstrated axial laxity with transection of the DR ligament; an increase in stability was obtained after DR capsulodesis. Transection of the capsule and IM ligament caused increased laxity relative to the native joint (median, 24° and 35°, respectively, on rotational testing). After we performed DR capsulodesis, rotational stability improved by a median of 41° compared with DR ligament transection, 49° compared with DR and IM ligament transection, and 18° relative to the native joint.ConclusionsDorsoradial capsulodesis restores rotational stability for TMC joint after division of the DR and IM ligaments. The stability achieved was statistically significant compared with both an intact native TMC joint and induced laxity of the TMC joint.Clinical relevanceThe DR capsulodesis procedure may improve rotational stability to the TMC joint.