Clinical outcome comparison of suture button suspensionplasty versus trapeziectomy with ligament reconstruction and tendon interposition in patients with carpometacarpal joint arthritis: a systematic review of direct comparison studies.

Abstract

Introduction: Trapeziectomy nowadays is predominantly done with Ligament Reconstruction and Tendon Interposition (LRTI) or Suture Button Suspensionplasty (SBS). This article is intended to highlight comparison between SBS and trapeziectomy with LRTI through direct comparison evidence.

Material and method: The LRTI technique involves the removal of the diseased trapezium bone and creating suspension through the use of flexor carpi radialis tendon, while SBS stabilize the metacarpal base by suspending the first metacarpal bone. The record screening process of this systematic and meta-analysis was in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. QuickDASH, post-operative strength, visual analog scale were set as the primary outcomes, while the adverse event reported and miscellaneous findings worth mentioning per study were set as the secondary outcomes.  Results: Of the 102 records screened, 1 Randomized Control Trial (RCTs) and 1 Cohorts, consisting of 188 cases were included in the analysis. Both modalities showed comparable, non-significant difference in efficacy (alleviating pain associated with basal joint arthritis, improving strength and function of the affected thumb, in the long term) at the endpoint of the follow-up. Both procedures also showcased excellent safety and long-term functional profile. However, SBS displayed an advantage in post-operative recovery aspect as well as the biomechanical aspect compared to LRTI.  Conclusions: Both LRTI & SBS demonstrated non-inferiority to each other, hence clinical judgment might be more based on the preference and tolerability of the patient, as well as the experience of the center. Further prospective, comparative study might be needed to truly erect the superiority of one of the procedures to another.