Arthroscopic-Assisted Suspensionplasty Using the Palmaris Longus Tendon for Osteoarthritis of the Thumb Carpometacarpal Joint  Taku Hatta, MD, PhD, Kiyotsugu Shinagawa, MD, Eiji Itoi, MD, PhD  Journal of Hand Surgery Global Online  Volume 1, Issue 2, Pages 105-110 (April 2019) DOI: 10.1016/j.jhsg.2019.03.001 Copyright © 2019 The Authors Terms and Conditions

Figure 1 Arthroscopic view from the 1R portal, confirming a flat or slightly concave surface of the trapezium after partial resection. The left CMC joint is shown. M2, second metacarpal; Tm, trapezium. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions

Figure 2 A Schematic illustration of the creation of a tunnel at the second metacarpal. The radial part of the tunnel is enlarged with a 3.5-mm cannulated drill. B Arthroscopic view from the 1U portal. The left CMC joint is shown. M2, second metacarpal. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions

Figure 3 Schematic illustrations. A Creation of a tunnel at the first metacarpal B A loop of number 2 FiberWire (L) is advanced through the tunnels. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions

Figure 4 Schematic illustrations and arthroscopic views of suspension graft insertion. A, B The PL tendon graft (G) and a broad high-strength suture (S) derived from a soft anchor placed in the first metacarpal are shuttled through the loop (L) (blue arrows). C, D The loop is carefully withdrawn until the suspension graft reaches the enlarged tunnel in the second metacarpal. The left CMC joint is shown. M1, first metacarpal; M2, second metacarpal. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions

Figure 5 A Schematic illustration of the suspension graft secured to the second metacarpal. According to the concept of the tension slide technique, both a cortical button and an interference screw are used for fixation. B Arthroscopic view from the 1U portal, confirming the placement of the interference screw in the tunnel of the second metacarpal. The left CMC joint is shown. M2, second metacarpal. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions

Figure 6 Schematic illustration of the suspension graft secured to the first metacarpal. In addition to the second metacarpal, a dual fixation mechanism is applied to the fixation of the suspension graft at the first metacarpal. An interference screw is placed in the first metacarpal tunnel and the broad high-strength suture is tied to the soft anchor to improve the pull-out strength of the graft. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions

Figure 7 Postoperative radiograph taken at 1 year after surgery. Journal of Hand Surgery Global Online 2019 1, 105-110DOI: (10.1016/j.jhsg.2019.03.001) Copyright © 2019 The Authors Terms and Conditions