Suture-Button Suspensionplasty Does Not Provide a Sustained Functional Advantage Over Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Arthritis

Purpose Surgical treatment of thumb carpometacarpal arthritis is common, with more than 40,000 procedures performed annually in the United States. Ligament reconstruction and tendon interposition (LRTI) remains a widely used technique with extensive longitudinal data, whereas suture-button suspensionplasty (SBS) has emerged as an alternative that avoids tendon harvest. This study compared early recovery patterns, patient-reported outcomes, and complications following LRTI and SBS. Methods Patients who underwent thumb carpometacarpal arthroplasty at a single academic tertiary care center between 2015 and 2023 were retrospectively identified. Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity (UE), Physical Function (PF), Pain Interference, and Depression, along with visual analog scale pain scores were collected before surgery and after surgery. Analysis of covariance was used to compute adjusted mean outcomes, controlling for age, sex, body mass index, comorbidity burden, baseline PROMIS scores when applicable, and bilateral surgery status. Postoperative complications were identified through medical record review. Results A total of 479 patients (524 hands) met inclusion criteria, including 409 patients (447 hands) treated with SBS and 70 patients (77 hands) treated with LRTI. No differences were observed between groups in PROMIS UE scores at any postoperative time point. Patient-Reported Outcomes Measurement Information System PF scores differed at 6 weeks; however, this difference was not mirrored by PROMIS UE and did not persist beyond 3 months. By 3 months after surgery, patient-reported outcomes and visual analog scale pain scores were similar between groups. Postoperative sensory disturbance was observed more frequently following SBS. Conclusions Within the PROMIS UE domain, early functional recovery did not differ between LRTI and SBS. The absence of corresponding differences in PROMIS UE suggests that isolated early differences in PROMIS PF likely reflect limitations in instrument responsiveness rather than true differences in hand-specific recovery. Overall, these findings do not support early functional superiority of either technique. Type of study/level of evidence Therapeutic IVb.

Duke Scholars

Author Warren Hammert Orthopaedic Surgery