031 Form

1

Medical Policy Suture Button Suspensionplasty Fixation System for Thumb Carpometacarpal Osteoarthritis Table of Contents • Policy: Commercial • Coding Information
• Information Pertaining to All Policies
• Policy: Medicare • Description
• References
• Authorization Information • Policy History

Policy Number: 031 BCBSA Reference Number: 7.01.176 (For Plan internal use only) NCD/LCD: N/A
Related Policies
None Policy Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity
Medicare HMO BlueSM and Medicare PPO BlueSM Members

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

Prior Authorization Information
Inpatient • For services described in this policy, precertification/preauthorization IS REQUIRED for all products if the procedure is performed inpatient.
Outpatient • For services described in this policy, see below for products where prior authorization might be required if the procedure is performed outpatient.

Outpatient Commercial Managed Care (HMO and POS) This is not a covered service. Commercial PPO and Indemnity This is not a covered service. Medicare HMO BlueSM This is not a covered service. Medicare PPO BlueSM This is not a covered service.

CPT Codes / HCPCS Codes / ICD Codes
Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member’s contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

2

Providers should report all services using the most up-to-date industry-standard procedure, revenue, and diagnosis codes, including modifiers where applicable. CPT Codes There are not any specific codes for this procedure. Description 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.1,

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.2, 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.3,

Multiple surgical techniques to treat thumb CMC osteoarthritis have been developed but there is currently no consensus on the optimal approach.3,4,5, 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.

Summary
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.

Summary of Evidence For individuals with thumb carpometacarpal (CMC) joint osteoarthritis who receive trapeziectomy with suture button suspensionplasty (SBS), the evidence includes a systematic review, 1 randomized controlled trial (RCT), 1 prospective, comparative observational study, and multiple nonrandomized, retrospective studies. Relevant outcomes are symptoms, functional outcomes, and adverse events. A single-center RCT compared trapeziectomy with SBS to trapeziectomy with ligament reconstruction and tendon interposition (LRTI) in 76 individuals. The RCT had multiple methodologic limitations, including

3

lack of blinding, inappropriate handling of missing data, and no pre-specification of outcome measures testing for non-inferiority. Pain and functional outcomes did not differ between intervention groups after 40 months of follow-up, although operative and recovery time was shorter in the suspensionplasty group. A prospective cohort study of 112 consecutive individuals who underwent suture button suspensionplasty or LRTI found similar improvements in pain scores and function with both procedures, but was limited by a lack of blinding and randomization. The evidence is insufficient to determine that the technology results in an improvement in the net health outcome. Policy History Date Action 12/2025 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 12/2024 Annual policy review. Description, summary, and references updated. Policy statements unchanged. 3/2024 New medical policy describing investigational indications. Suture button suspensionplasty for thumb carpometacarpal joint osteoarthritis is considered investigational. Effective 3/1/2024. Information Pertaining to All Blue Cross Blue Shield Medical Policies Click on any of the following terms to access the relevant information: Medical Policy Terms of Use Managed Care Guidelines Indemnity/PPO Guidelines Clinical Exception Process Medical Technology Assessment Guidelines References

1. Wininger AE, Orozco EI, Han A, et al. Systematic Comparison of Ligament Reconstruction With Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis. Hand (N Y). Oct 2023; 18(7): 1069-1079. PMID 35272518
2. Kolasinski SL, Neogi T, Hochberg MC, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Care Res (Hoboken). Feb 2020; 72(2): 149-162. PMID 31908149
3. Shah ND, Yuksel S, Sasson DC, et al. A 15-Year Review of Clinical Practice Patterns and Evidence- Based Medicine in Carpometacarpal Joint Arthroplasty. Hand (N Y). Mar 2023; 18(2_suppl): 65S- 73S. PMID 34969303
4. Wajon A, Vinycomb T, Carr E, et al. Surgery for thumb (trapeziometacarpal joint) osteoarthritis. Cochrane Database Syst Rev. Feb 23 2015; 2015(2): CD004631. PMID 25702783
5. Challoumas D, Murray E, Ng N, et al. A Meta-analysis of Surgical Interventions for Base of Thumb Arthritis. J Wrist Surg. Dec 2022; 11(6): 550-560. PMID 36504527
6. Food & Drug Administration. 2014. Arthrex CMC Mini Tightrope. 510K Summary of Safety and Effectiveness. https://www.accessdata.fda.gov/cdrh_docs/pdf14/K140328.pdf. Accessed August 25,
8. Wu EJ, Fossum BW, Voort WV, et al. Surgeon preferences in the treatment of thumb carpometacarpal osteoarthritis. World J Orthop. May 18 2024; 15(5): 435-443. PMID 38835687
9. Morais B, Botelho T, Marques N, et al. Trapeziectomy with suture-button suspensionplasty versus ligament reconstruction and tendon interposition: a randomized controlled trial. Hand Surg Rehabil. Feb 2022; 41(1): 59-64. PMID 34728434
10. Shinya Y, Ikeguchi R, Noguchi T, et al. Radiographic Evaluation after Arthroscopic Partial Trapeziectomy with Suture-button Suspensionplasty for Thumb Carpometacarpal Arthritis. Plast Reconstr Surg Glob Open. May 2023; 11(5): e4983. PMID 37180981
11. Franchignoni F, Vercelli S, Giordano A, et al. Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH). J Orthop Sports Phys Ther. Jan 2014; 44(1): 30-9. PMID 24175606

4

11. Shonuga O, Nicholson K, Abboudi J, et al. Thumb-Basal Joint Arthroplasty Outcomes and Metacarpal Subsidence: A Prospective Cohort Analysis of Trapeziectomy With Suture Button Suspensionplasty Versus Ligament Reconstruction With Tendon Interposition. Hand (N Y). Jan 2023; 18(1): 98-104. PMID 33789518
12. Walter N, Duncan E, Roskosky M, et al. Suture Button Suspensionplasty in the Treatment of Carpometacarpal Arthritis: A Retrospective Analysis of One Surgeon's Experience Over 9 Years. J Hand Surg Glob Online. Jan 2020; 2(1): 25-30. PMID 35415470
13. Yao J, Cheah AE. Mean 5-Year Follow-up for Suture Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Joint Osteoarthritis. J Hand Surg Am. Jul 2017; 42(7): 569.e1-569.e11. PMID 28412189
14. Yao J, Song Y. Suture-button suspensionplasty for thumb carpometacarpal arthritis: a minimum 2- year follow-up. J Hand Surg Am. Jun 2013; 38(6): 1161-5. PMID 23647637
15. Özçelik İB, Uğurlar M, Sarı A. Arthroscopic Hemitrapeziectomy and Suture Button Suspensionplasty in the Treatment of First Carpometacarpal Joint Eaton-Littler Stage 2-3 Arthrosis. J Wrist Surg. Apr 2019; 8(2): 132-138. PMID 30941253
16. Tanaka H, Muraoka K, Tanaka Y, et al. Suspension arthroplasty using the palmaris longus tendon with a suture button for thumb trapeziometacarpal arthritis: a retrospective observational study. J Orthop Sci. Jul 2023; 28(4): 795-801. PMID 35690542
17. Maeda A, Ikeguchi R, Noguchi T, et al. Clinical Results of Arthroscopic Partial Trapeziectomy With Suture-Button Suspensionplasty for Thumb Carpometacarpal Arthritis. Hand (N Y). Jul 2023; 18(5): 740-745. PMID 35156403
18. Landes G, Gaspar MP, Goljan P, et al. Arthroscopic Trapeziectomy With Suture Button Suspensionplasty: A Retrospective Review of 153 Cases. Hand (N Y). Jun 2016; 11(2): 232-7. PMID 27390569
19. Avant KR, Nydick JA, White BD, et al. Basal joint osteoarthritis of the thumb: comparison of suture button versus abductor pollicis longus suspensionplasty. Hand (N Y). Mar 2015; 10(1): 80-4. PMID 25767424
20. Das T, Mishra J, Chawla S, et al. Trapeziectomy and Mini TightRope Suspensionplasty for First Carpometacarpal Joint Arthritis. Cureus. Aug 2024; 16(8): e67695. PMID 39318898
21. Lachnish J, Titan AL, Sen S, et al. Long-Term Results of Suture-Button Suspensionplasty in the Treatment of Thumb Carpometacarpal Arthritis: A Minimum 10-Year Follow-Up. J Hand Surg Glob Online. Mar 2024; 6(2): 206-211. PMID 38903836