GraftJacket Versus Tendon Interposition for Trapeziometacarpal Osteoarthritis
GraftJacket Versus Tendon Interposition for Trapeziometacarpal Osteoarthritis
Studies at the shoulder, Achilles tendon and thumb show satisfactory results regarding the
 use of GaftJacket. Initial trials at the thumb show, that the GraftJacket can be safely and
 successfully used in TMC OA surgery and therefore represents an acceptable alternative for
 avoiding possible donor-site morbidity. However, there are no randomised controlled trials
 (RCT) in which the outcomes of using a tendon interposition or the GraftJacket are compared.
 Only with an RCT design it is possible to gain evidence about the advantages of one treatment
 method over another. The main objective of the study is the comparison between two surgical
 techniques for TMC OA: The resection interposition suspension arthroplasty using a part of
 the flexor carpi radialis tendon as interpositional material and using the GraftJacket as
 interpositional material.
Besides the use of the flexor carpi radialis tendon, several materials can serve as the
 interposition tissue including Gore-Tex, silicone and other types of metal or polymer
 implants. The use of Gore-Tex, silicone and metal implants, have been shown to carry high
 complication rates secondary to synovitis and mechanical failure combined with poor patient
 outcomes. A study about a porcine collagen xenograft was terminated prematurely because of
 poor outcomes and adverse immunologic reactions.

 Another option is using allograft, which is dermal or tendon tissue from another human donor
 such as the GraftJacket (Wright Medical Technology, Inc., Arlington, TN). This product is
 manufactured from donated cadaveric tissue that is treated to remove all cellular components
 while preserving the native collagen scaffold. It thus provides the strength and integrity of
 native autograft without the adverse immunologic response of traditional allograft. It is in
 compliance with the American Association of Tissue Banks guidelines for allograft material,
 and it is classified as human tissue for transplantation.

 The GraftJacket shows high biocompatibility and the advantages compared to autograft are
 avoiding donor site morbidity as well as decreased surgical time.

 GraftJacket has mainly being used for the repair of rotator cuff tears and Achilles tendons
 ruptures. No complications have been reported and patients showed significant improved
 outcomes compared with their preoperative conditions. Although all of the studies show
 methodological limitations due to the lack of a control group, these results show a great
 potential and warrant further investigations.

 In contrast to the studies already conducted in the Achilles tendon and shoulder joint, there
 are only sparse data concerning other joints of the upper extremity such as the elbow and the
 hand. Treating TMC OA of Eaton stage ll, lll and lV with GraftJacket has only been reported
 in two studies. The patients under investigation reported significant pain relief,
 significant improvements regarding grip and key pinch strength, good ability to perform
 activities of daily living (ADL) and high satisfaction rates. No or only minimal
 postoperative complications such as paraesthesia which are not directly related to the
 GraftJacket have been reported. However, some limitations of these two studies have to be
 acknowledges. Both are observational studies without control group making it impossible to
 conclude if this approach is favourable compared to standard techniques.
Inclusion criteria:

 -  All adult patients diagnosed for TMC OA

 -  willing to participate and provide informed consent

 Exclusion criteria:

 -  Patients with rheumatoid arthritis,

 -  pregnant women,

 -  legal incompetent patients,

 -  persons with insufficient knowledge of the German language to complete the
 questionnaires