Comparative Efficacy of Suture Suspensionplasty versus LRTI: A Systematic Review on Functional Outcomes and Surgical Efficiency
Raven Hollis, Emily T Yan, DO, Rachel Safo, Kiana C Allen, Jacob Niehaus, Rolanda Willacy, MD* and Marvin Dingle, MD
ABSTRACT
Introduction: Suture suspensionplasty (SS) is a minimally invasive surgical technique for treating thumb carpometacarpal (CMC) arthritis, characterized by pain, stiffness, and reduced grip strength. Unlike ligament reconstruction and tendon interposition (LRTI), SS avoids the need for tendon harvest and bone grafting. This review aimed to compare SS and LRTI in terms of functional outcomes, radiographic measures, complications, and operative efficiency.
Methods: A systematic review was conducted following PRISMA guidelines. PubMed, EMBASE, Cochrane Library, and Google Scholar were searched for studies published between 2015 and 2025. Inclusion criteria were comparative studies of SS versus LRTI or trapeziectomy in adults (≥18 years) with primary thumb CMC osteoarthritis (Eaton-Littler stages II–IV). Outcomes included patient-reported scores (DASH, PRWE), objective measures (grip and pinch strength), radiographic outcomes (metacarpal subsidence), complications, and operative time. Study selection involved independent title/abstract screening and full-text review, and data extraction followed a standardized protocol.
Results: Database searches identified 25 studies (n = 1,427). After exclusions, 21 studies were included. Pain relief, function, and DASH scores were comparable between SS and LRTI. Radiographic outcomes showed mixed findings, with some studies indicating less metacarpal subsidence with SS. SS consistently demonstrated procedural advantages, including shorter operative times, a single-incision approach, and elimination of tendon harvest or implantable hardware. Complication rates were similar across procedures.
Conclusion: SS provides clinical outcomes equivalent to LRTI while offering procedural efficiency and minimal invasiveness. Shortterm functional recovery may be faster, although variability in study design and limited long-term data highlight the need for standardized prospective studies.
