title: Trapeziometacarpal Ligaments Biomechanical Study: Implications in Arthroscopy.
abstract: PurposeIn the presence of early osteoarthritis, changes to the trapeziometacarpal joint (TMJ) often result in pain and is associated with joint instability and a tendency of dorsoradial subluxation. In these instances, arthroscopy may be indicated to: (1) assess the extent of cartilage disease and the laxity of ligaments and to (2) treat TMJ instability. The purpose of our study was to biomechanically analyze which ligaments are the primary stabilizers of the TMJ.MethodsOverall, 11 fresh-frozen human cadaver specimens were dissected and attached to a testing device with the thumb positioned in neutral abduction, neutral flexion, and neutral opposition. The four extrinsic and five intrinsic muscle tendons acting on the TMJ were simultaneously loaded with weights proportional to their physiological cross-sectional area. The dorsal, volar, and ulnar groups of ligaments were dissected. A motion-tracking device, FasTrak (Polhemus Inc., Colchester, VT), was used to study the spatial position of the base of the first metacarpal bone (MC1), before and after random sectioning of each of the ligaments. Statistical analysis of the MC1 translation along the transverse XY plane was performed using one-way analysis of variance and a pairedt-test, with a significance level ofp< 0.05.ResultsAfter isolated sectioning of the volar or the ulnar ligaments, the MC1 moved dorsoradially with an average of 0.150 mm (standard deviation [SD]: 0.072) and 0.064 mm (SD: 0.301), respectively. By contrast, the destabilization of the MC1 after sectioning of the dorsal ligaments was substantially larger (0.523 mm; SD: 0.0512;p= 0.004).ConclusionSectioning of the dorsal ligament group resulted in the greatest dorsoradial translation of the MC1. Consequently, the dorsal ligaments may be regarded as the primary TMJ stabilizers.Clinical RelevanceThis study suggests that stabilizing arthroscopic shrinkage of the TMJ should be targeted toward the dorsal TMJ ligaments.
authors: Clinica Activamutua, Tarragona, Spain.
authors: Mireia
authors: M
authors: Esplugas
authors: Institut Kaplan, Barcelona, Spain.
authors: Alex
authors: A
authors: Lluch-Bergada
authors: Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden; Department of Hand and Plastic Surgery, Stavanger University Hospital, Stavanger, Norway.
authors: Nathalie
authors: N
authors: Mobargha
authors: Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain.
authors: Manuel
authors: M
authors: Llusa-Perez
authors: Karolinska Institutet Södersjukhuset, Institutionen för klinisk forskning och utbildning, Stockholm, Sweden; Hand and Foot Surgery Center, Stockholm, Sweden.
authors: Elisabet
authors: E
authors: Hagert
authors: Institut Kaplan, Barcelona, Spain.
authors: Marc
authors: M
authors: Garcia-Elias
keywords: TMJ arthroscopy; TMJ biomechanics; TMJ instability; TMJ ligaments; thumb arthroscopy