What's In My Bag? CMC TightRope with Jeffrey Yao, MD
Q. How long have you been using the Mini TightRope for CMC arthritis?
A. Six years
Q. What are the overall benefits of using the TightRope versus a more traditional ligament reconstruction tendon interposition (LRTI) or hematoma distraction arthroplasty?
A. By using the TightRope, I don’t have to wait for soft tissue reconstruction to heal (LRTI, APL suspensionplasty) and I also don’t have to leave any external K-wires to maintain the trapeziectomy space (hematoma distraction arthroplasty). Therefore, I can initiate a rehabilitation protocol as early as 5–7 days after surgery with this implanted device, maintaining my trapeziectomy space.
Q. What type of patient is the TightRope indicated for?
A. Any patient with thumb carpometacarpal joint arthritis that fails nonsurgical treatment measures (such as splints, injections, activity modifications and therapy).
Q. How has this changed your post-op protocol?
A. This device has been a game changer for me because instead of immobilizing my patients for four weeks (with or without an external K-wire), I am able to accelerate the post-op protocol by starting it 5–7 days following surgery. I don’t start therapy immediately because I do believe a week is appropriate to allow the skin and other soft tissues to heal, but I suppose immediate therapy would be ok as well with this technique.
Q. How many patients have you performed this procedure on?
A. Over 50.
Q. How have your patients responded to the CMC Mini TightRope in contrast to previous technique options?
A. The overall recovery is much faster with this technique. Typical full recovery is around three months as compared to 3–6 months or more for my previously-preferred techniques (arthroscopic hemitrapeziectomy and pinning for four weeks or APL suspensionplasty). It has been most telling in my patients who had one of those previous procedures on one thumb and then had the TightRope suspensionplasty on the second thumb and they have been universally happier with the TightRope procedure because of the decreased recovery time.