Sequential Wear Patterns of the
Articular Cartilage of the Thumb
Carpometacarpal Joint in
Osteoarthritis
Matthew F. Koff, MS, Obinwanne F. Ugwonali, MD,
Robert J. Strauch, MD, Melvin P. Rosenwasser, MD,
Gerard A. Ateshian, PhD, Van C. Mow, PhD, New York, NY
Purpose: The thumb carpometacarpal (CMC) joint is a primary location for osteoarthritis (OA) in
the body; however, articular cartilage thickness distribution during progression of OA in the joint
has not been reported previously. Determining the cartilage wear patterns within the joint is
important in understanding the etiology and treatment of thumb CMC joint OA. This study used
cadaveric specimens to investigate the wear patters of the articular surfaces of the trapezium and
thumb metacarpal.
Methods: A total of 104 fresh-frozen thumb CMC joints were radiographed, disarticulated, and
visually staged for OA. Cartilage thickness maps of the trapezium and metacarpal were determined
for each joint by using stereophotogrammetry. Average cartilage thickness maps for the trapezium
and metacarpal were generated from all specimens for each of 4 stages of OA, showing the
progression of cartilage thickness changes with disease.
Results: In normal joints, the surface-wide mean thickness of the articular layers is 0.8 0.2 mm
for the trapezium and 0.7 0.2 mm for the metacarpal. The average thickness maps were analyzed
by anatomic quadrant (dorsal-radial, dorsal-ulnar, volar-radial, volar-ulnar) within the 4 stages of
OA. Corresponding quadrants also were compared across the increasing stages of OA. Results
show that cartilage degradation is initiated in the radial quadrants of the metacarpal and progresses
to the volar quadrants of the articular surface, while significant wear is seen on the dorsal-radial
quadrant of the trapezium and progresses to the volar quadrants in late-stage osteoarthritis.
Conclusions: These quantitative results on cartilage thinning agree with previous investigators’
reports of high load bearing and low load bearing areas in the CMC joint during functional pinch
and grasp positions. Understanding the progression of OA in the thumb CMC joint may aid in the
surgical treatment of this disease. (J Hand Surg 2003;28A:597– 604. Copyright © 2003 by the
American Society for Surgery of the Hand.)
Key words: Thumb, cartilage, osteoarthritis, carpometacarpal.
From the Department of Biomedical Engineering and the Department of Orthopaedic Surgery, Columbia University, New York, NY.
Received for publication January 24, 2003; accepted in revised form March 24, 2003.
No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
Supported by a grant from the National Institutes of Health (R01-AR41020) and the Morin Foundation (M.F.K.).
Reprint requests: Gerard A. Ateshian, PhD, Department of Mechanical Engineering, Columbia University, 500 W 120th St, Mail Code 4703, 220 S.W.
Mudd, New York, NY 10027-6699.
Copyright © 2003 by the American Society for Surgery of the Hand
0363-5023/03/28A04-0008$30.00/0
doi:10.1016/S0363-5023(03)00145-X
The Journal of Hand Surgery 597