Suture Button Suspensionplasty Fixation System for Thumb Carpometacarpal Osteoarthritis

POLICY NUMBER

A.7.01.176

DESCRIPTION

In the thumb, the most common site for arthritis to develop is in the joint at the base of the thumb, also known as the carpometacarpal (CMC) joint. Pain and functional limitations associated with symptomatic thumb CMC joint osteoarthritis, especially when pinching or gripping objects, can significantly interfere with quality of life. Surgery is indicated when conservative measures fail to provide sufficient relief and functional improvement. There is currently no consensus on the optimal surgical approach, but the most frequently used procedure is trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Trapeziectomy using suture button suspensionplasty (SBS) is proposed as a less invasive alternative to trapeziectomy with LRTI.

Thumb Carpometacarpal Joint Osteoarthritis

In the thumb, the most common site for arthritis to develop is in the joint at the base of the thumb, also known as the carpometacarpal (CMC) joint. The incidence of CMC joint osteoarthritis is estimated to be 5% to 33% among adults in their 50s and 60s, and rises with age. It is more common in postmenopausal women. Pain and functional limitations, especially when pinching or gripping objects, can significantly interfere with quality of life.

First-line treatment of CMC joint osteoarthritis includes non-surgical measures such as activity modifications, rest, hand orthosis, anti-inflammatory medications, physical therapy, and corticosteroid injections. Surgery is indicated when conservative treatment fails to provide sufficient relief and functional improvement. Although thumb CMC joint osteoarthritis is often staged using radiological classification systems (e.g., the Eaton-Littler classification), the severity of symptoms does not necessarily correspond to radiographic findings; therefore a decision to proceed to surgery is based on symptoms and degree of disability.

Multiple surgical techniques to treat thumb CMC osteoarthritis have been developed but there is currently no consensus on the optimal approach. The most common surgical technique is removal of the trapezium bone at the base of the thumb (trapeziectomy). Trapeziectomy can be performed alone but is most commonly performed in conjunction with reconstruction of the ligament that holds the bones between the thumb and index finger together, and filling the space left behind by the removed trapezium with tendon harvested from the forearm to support the thumb. This procedure is known as trapeziectomy with ligament reconstruction and tendon interposition (LRTI). Either the flexor carpi radialis (FCR) tendon or abductor pollicis longus (APL) tendon is used in this procedure.

Trapeziectomy using suture button suspensionplasty is proposed as a less invasive alternative to trapeziectomy with LRTI. Instead of using tendon to support the thumb, the procedure suspends the first metacarpal to the second using a strong suture material (fiberwire) passed through both bones. A button on each of the metacarpals is attached to either end of the suture to secure the bones in the correct position.

In 2014, the CMC Mini TightRope System (Arthrex, Inc) was FDA cleared through the 510K process. Clearance was based on a determination that the device is substantially equivalent to the predicate device Arthrex Implant System (Mini TightRope). The CMC MiniTightRope system is indicated for CMC joint arthroplasty as an adjunct in the suspension of the thumb metacarpal by providing stabilization at the base of the first and second metacarpal when the trapezium has been excised due to osteoarthritis.

Related medical policies –

• Synthetic Cartilage Implants for Joint Pain

POLICY

Suture button suspensionplasty for thumb carpometacarpal joint osteoarthritis is considered investigational.

POLICY EXCEPTIONS

Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.

POLICY GUIDELINES

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.

POLICY HISTORY

05/01/2024: New policy added. Approved by the Medical Policy Advisory Committee.

01/14/2025: Policy reviewed; no changes.

SOURCE(S)

Blue Cross Blue Shield Association policy # 7.01.176

CODE REFERENCE

This may not be a comprehensive list of procedure codes applicable to this policy.

Investigational Codes

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