Thumb Metacarpophalangeal Hyperextension in Patients Undergoing Basilar Thumb Joint Suspensionplasty: Are Preoperative Passive Measurements Predictive of Failure?
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42246901.
- Also identified by DOI 10.1016/j.jhsa.2026.05.002.
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Abstract
To evaluate whether a 30° passive metacarpophalangeal (MCP) joint hyperextension threshold was associated with postoperative mechanical and patient-reported outcomes when leaving MCP joint hyperextension unaddressed after performing trapeziectomy with suspensionplasty. This prospective observational study evaluated adults with symptomatic thumb carpometacarpal osteoarthritis and passive MCP joint hyperextension ≥10° who underwent trapezial resection and suspensionplasty without concurrent MCP joint stabilization. Patients were stratified by baseline passive MCP joint hyperextension: <30° and ≥30°, with measurements obtained before surgery and at 12 months after surgery. The primary outcome was the between-group difference in change over time for MCP joint position during key pinch. Secondary outcomes included between-group differences in change over time for MCP joint position during jar and cap grasp; carpometacarpal joint position during key pinch, jar grasp, and cap grasp; grip and pinch strength; first-second metacarpal angle; trapezial space ratio; and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. We did not observe a statistically significant difference between groups in change over time for the primary outcome of MCP joint position during key pinch, or for secondary dynamic MCP joint and carpometacarpal joint outcomes, with most patients positioning the MCP joint in flexion. We also did not detect a difference in change over time between groups for pinch and grip strength, first-second metacarpal angle, trapezial space ratio, or DASH scores. In our prospective assessment, we did not detect an association between preoperative measures of ≥30° passive MCP joint hyperextension and 12-month dynamic mechanics, strength, radiographic measures, or DASH scores after trapeziectomy with suspensionplasty. Dynamic measures may complement passive thresholds to characterize MCP joint behavior. Larger studies are needed to define the true role of MCP joint stabilization for trapeziectomy with suspensionplasty, as this study may have been underpowered to detect smaller effects. Therapeutic 2b.