title: Trapeziometacarpal joint stability: the evolving importance of the dorsal ligaments.
abstract: BACKGROUND
  Trapeziometacarpal (TMC) arthritis of the thumb is a common source of hand pain and disability. TMC ligamentous instability may play a role in TMC degeneration. However, the relative importance of the TMC ligaments in the etiology of degeneration and the use of surgery to treat instability in early-stage arthritis are unclear.
  
  
  OBJECTIVE
  In this review, we addressed several questions: (1) What are the primary ligamentous stabilizers of the thumb TMC joint? (2) What is the evidence for ligament reconstruction or ligament imbrication in the treatment of thumb TMC joint osteoarthritis? And (3) what is the evidence for thumb metacarpal osteotomy in the treatment of thumb TMC joint osteoarthritis?
  
  
  METHODS
  We performed a systematic review of the literature using PubMed (MEDLINE(®)) and Scopus(®) (EMBASE(®)) for peer-reviewed articles published until November 2012. Fifty-two studies fit the inclusion criteria. Twenty-four studies were anatomic, biomechanical, or histopathologic studies on TMC joint ligamentous anatomy, 16 studies were clinical studies concerning ligament reconstruction, and 12 studies were clinical studies on thumb metacarpal osteotomy.
  
  
  RESULTS
  Over the past two decades, increasing evidence suggests the dorsoradial ligament is the most important stabilizer of the TMC joint. Other ligaments consistently identified are the superficial anterior oblique, deep anterior oblique, intermetacarpal, ulnar collateral, and posterior oblique ligaments. Ligament reconstruction and metacarpal osteotomy relieve pain and improve grip strength based on Level IV studies.
  
  
  CONCLUSIONS
  The dorsal ligaments are the primary stabilizers of the TMC joint. Ligament reconstruction and metacarpal osteotomy ameliorate ligamentous laxity and relieve pain based on Level IV studies.
authors: Columbia University Medical Center, 622 W 168th Street, PH11, New York, NY, 10032, USA.
authors: James D
authors: JD
authors: Lin
authors: John W
authors: JW
authors: Karl
authors: Robert J
authors: RJ
authors: Strauch
mesh_terms: D001696:Biomechanical Phenomena; D052737:Carpometacarpal Joints / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology* / Q000601:surgery; D008022:Ligaments / Q000503:physiopathology* / Q000601:surgery; D010003:Osteoarthritis / Q000503:physiopathology* / Q000601:surgery; D010027:Osteotomy; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D051222:Trapezium Bone / Q000503:physiopathology* / Q000601:surgery; D016896:Treatment Outcome