***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established . A prospect i ve , r and omized study was performed . In Group I ( nine patients ) , ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium . In Group II ( 11 patients ) , ligament reconstruction alone was performed , with use of a Mitek suture anchor . No tendon interposition was performed . This allowed use of a more limited incision and shorter length of tendon graft . Average followup was 23 months . There was no difference between the two groups in range of motion of the thumb , grip strength , lateral pinch strength , the ability to perform activities of daily living , or subjective satisfaction with the procedure . Two- and three-point pinch strength was statistically significantly greater in Group II . Lateral radiographs of the basal joint at followup , at rest and with pinch , showed maintenance of the joint space , and no difference between the two groups . Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed Seventy-three thumbs in 67 women with osteoarthritis of the trapeziometacarpal joint were assessed prospect ively . The patients were r and omly allocated for treatment by either trapeziectomy alone ( n = 26 ) or trapeziectomy with tendon interposition ( n = 23 ) or ligament reconstruction ( n = 24 ) . A K-wire was passed through the thumb metacarpal base and across the trapezial space into the distal pole of the scaphoid in all procedures ; this held the base of the metacarpal away from the scaphoid for 4 weeks . St and ard thumb radiographs were used to calculate the trapezial space ratio before surgery and at 1-year follow-up examination . The trapezial space ratio decreased significantly from a preoperative mean of 0.40 ( range , 0.20 - 0.56 ) to a mean of 0.18 ( range , 0.08 - 0.30 ) after trapeziectomy , 0.16 ( range , 0.07 - 0.30 ) after trapeziectomy with tendon interposition , and 0.20 ( range , 0.00 - 0.33 ) after trapeziectomy with ligament reconstruction . There was no significant difference between these 1-year follow-up trapezial space ratios , suggesting that the placement of a K-wire across the trapezial void is as effective as tendon interposition  or ligament reconstruction in creating a trapezial space in the short term at least . However , the need to create a trapezial space and maintain thumb length is question ed because the trapezial space height did not correlate with thumb strength at 1-year follow-up examination Forty-three h and s in 41 adults with osteoarthrosis of the trapeziometacarpal joint were allocated r and omly to undergo  a trapeziectomy through either an anterior approach or the posterior ( dorsoradial ) approach .  Forty h and s were available for review at a median of 33 months postoperatively . The demographic characteristics , severity of disease and pre-operative measurements of the two groups were indistinguishable . Trapeziectomy result ed in significantly improved objective and subjective function in both groups , but the anterior approach group had better outcomes for power , scar tenderness and satisfaction . Scar-related complications were three times more common in the posterior group . Trapeziectomy is a good method of treating osteoarthritis of the thumb base , but outcomes for the anterior approach are equally good or better than with the posterior PURPOSE A new spacer for the trapeziometacarpal joint ( TMC ) based on a biological and tissue-preserving concept for the treatment of TMC osteoarthritis ( OA ) has been evaluated . The purpose was to combine a spacing effect with stabilization of the TMC joint . METHODS Artelon ( Artimplant AB , Sweden ) TMC Spacer is synthesized of a degradable polyurethaneurea ( Artelon ) , which has been shown to be biocompatible over time and currently is used in ligament augmentation procedures . Fibers of the polymer were woven into a T-shaped device in which the vertical portion separates the bone edges of the TMC joint and the horizontal portion stabilizes the joint . Fifteen patients with disabling pain and isolated TMC OA were included in the study . Ten patients received the spacer device and the remaining 5 ( control group ) were treated with a trapezium resection arthroplasty with abductor pollicis longus ( APL ) stabilization .  The median ages of the 2 groups were 60 and 59 years , respectively .  Pain , strength , stability , and range of motion were measured before and after surgery . Radiographic examination was performed in all patients before and after surgery . At follow-up evaluation 3 years after surgery an unbiased observer evaluated all patients . Biopsy specimens were obtained from 1 patient 6 months after surgery . RESULTS All patients were stable clinical ly without signs of synovitis . In both groups all patients were pain free . The median values for both key pinch and tripod pinch increased compared with before surgery in the spacer group but not in the APL group . The biopsy examinations showed incorporation of the device in the surface of the adjacent bone and the surrounding connective tissue . No signs of foreign-body reaction were seen . CONCLUSIONS This study showed significantly better pinch strength after Artelon TMC Spacer implantation into the TMC joint compared with APL arthroplasty Twenty-six h and s in 26 adults with osteoarthrosis of the thumb trapeziometacarpal joint were r and omised  to undergo either trapeziectomy alone ( control ) or with the interposition of porcine dermal collagen xenograft ( Permacol ™ ) . The study was terminated prematurely because of apparent reactions to the implants in six of 13 patients . The collagen interposition group required more frequent review on clinical grounds and were discharged later after surgery . Three of the implants have been removed and histology revealed foreign body reactions in all . There was no difference in thumb movement or power after surgery between the two groups . However , improved grip strength was observed and improved function were reported only in the control group . Permacol patients reported greater pain and were less satisfied with their operations than control patients . We conclude that interposition of Permacol is detrimental to the results of trapeziectomy This r and omized prospect i ve study compared the results of trapeziectomy alone , or combined with tendon interposition or ligament reconstruction in 76 women with basal thumb osteoarthritis . At 3 month and 1 year follow-up the results of the three procedures were indistinguishable in terms of pain relief , h and function and thumb strength . In the short term at least , tendon interposition and ligament reconstruction do not improve the results of trapeziectomy Forty-three patients were r and omly allocated to undergo either  trapeziectomy alone ( control ) or with a ligament reconstruction and tendon interposition ( LRTI ) using an abductor pollicis longus tendon slip .  The patients were review ed at a median 13 ( range , 7–29 ) months after surgery . The demographic characteristics , severity of disease and pre-operative clinical measurements of the two study groups were indistinguishable but LRTI lengthened the operation by approximately 15 minutes . Both groups expressed equal satisfaction with the operation and there were no significant differences between the two treatment groups . Simple trapeziectomy is an effective operation for osteoarthrosis at the base of the thumb and the addition of a ligament reconstruction was not shown to confer any additional benefit 
    Output:
    
2 ) Trapeziectomy with ligament reconstruction or trapeziectomy with ligament reconstruction and tendon interposition ( LRTI ) is not superior to any of the other techniques .
In addition , trapeziectomy with LRTI seems associated with a higher complication rate .
( 3 ) Because the studies on thumb carpometacarpal ( CMC ) arthrodesis were of less method ological quality and had inconsistent outcomes , we are not able to conclude whether CMC arthrodesis is superior to any other technique .
4 ) A study on joint replacement showed that total joint prosthesis might have better short-term results compared to trapeziectomy with LRTI .
In addition , there is no evidence that the Artelon spacer is superior to trapeziectomy with LRTI .
We conclude that , at this time , no surgical procedure is proven to be superior to another .
However , based on good results of CMC arthrodesis and total joint prostheses , we postulate that there could be differences between the various surgical procedures .