Revision Interposition Arthroplasty with AlloDerm for Persistent Thumb Carpometacarpal Pain Following TightRope Suspensionplasty: A Case Report.

Thumb carpometacarpal (CMC) arthritis causes thumb pain and disability, often requiring surgery when conservative treatments fail. Trapeziectomy with ligament reconstruction and tendon interposition remains a standard approach, but TightRope suspensionplasty offers a tendon-sparing alternative that allows early mobilization. This report discusses a 48-year-old police officer with advanced thumb CMC arthritis who underwent trapeziectomy with TightRope suspensionplasty. Although initially successful, she experienced ongoing pain during high-impact activities, especially when operating a firearm, which is essential for her job. The pain, occurring during thumb adduction and forceful loading, did not improve with conservative treatment. Revision surgery with AlloDerm and hardware removal was performed. Serial follow-up at 3, 6, and 12 months demonstrated progressive strength recovery and stable metacarpophalangeal alignment, with return to occupational duties with ergonomic modifications. This case highlights the potential of biologic interposition to manage load-related pain after suspensionplasty in high-demand individuals.