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What’s in my Bag? CMC TightRope for Revisions or Advanced Disease with John Safanda, MD


What’s in my Bag? CMC TightRope for Revisions or Advanced Disease with John Safanda, MD

CMC Mini TightRopeQ: When do you use the TightRope?

A:  I personally use the TightRope for all of my CMC arthroplasties. It is also a great option for advanced disease or in revision cases where tendon options may not be available.  

Q: How many patients have you performed this procedure on? What are your results?


 A: We began using the TightRope in 2009 and have performed the procedure on more than 150 patients. We recently completed the analysis of our first 100 patients.  We were able to maintain metacarpal height in all patients irrespective of their preoperative arthritic stage. We also showed a statistically significant improvement in thumb abduction postoperatively.  

Q: How has your surgical technique changed or evolved during the last five years?


A: The biggest change is that I quickly realized that I could place and secure the TightRope prior to excision of the trapezium. This allows us to precisely reconstruct the normal anatomy.  

Q: What are the advantages of the TightRope in cases of advanced CMC arthritis?


A: The TightRope affords improved suspension as compared with traditional LRTI because the axis of suspension is placed higher on the index metacarpal. This allows us to better restore the thumb metacarpal height. This is particularly helpful in revision cases with proximal migration or in cases of advanced arthritis.  

Q: Are there additional advantages?


A: Yes. By restoring the thumb metacarpal to its original height MP joint hyperextension is also improved. This has dramatically limited my need to perform stabilizing procedures or fusions at the MP joint.  

Q: What is your post-op protocol in these cases?


A: Because of the immediate stability the TightRope provides, I am able to place both my straightforward and complex/revision cases into an accelerated post-op protocol. Patients are splinted for one week following surgery. At one week the post-op splint is removed and physical therapy is initiated. In addition to motion exercises, we allow the patient to begin pinch and grip strength training on the first day of therapy. 

Category: Arthrex Blog
Disclaimer

The views expressed in these posts reflect the experience and opinions of the presenting surgeons and do not necessarily reflect those of Arthrex, Inc. This is not medical advice and Arthrex recommends that surgeons be trained in the use of any particular product before using it in surgery. A surgeon must always rely on his or her own professional clinical judgment when deciding whether to use a particular product when treating a particular patient. A surgeon must always refer to the package insert, product label and/or instructions for use before using any Arthrex product. Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Arthrex representative if you have questions about availability of products in your area.