With an aging population, the incidence of symptomatic thumb carpometacarpal joint arthritis (CMC) is on the rise. The incidence is higher in women overall, with 25% of post-menopausal women and over 40% of women aged greater than 70 years presenting with symptomatic carpometacarpal joint arthritis. The thumb CMC joint is second only to the distal interphalangeal joint as the most common arthritic joint in the hand. The thumb CMC joint is described as a saddle joint allowing multiple arcs and planes of motion. Surgical goals have focused on providing pain relief while maintaining motion and improving grip and pinch strength. Trapeziectomy with or without ligament reconstruction and tendon interposition (LRTI) have been advocated to as surgical treatment of choice for patients with debilitating CMC joint arthritis. Newer treatment methods to suspend the thumb metacarpal via a suture button suspensionplasty (SBS) have also shown favorable clinical results with superior biomechanical strength. It is the biomechanical superiority that may allow patients to achieve a successful outcome earlier and thus reduce their overall recovery time, returning to work and sport activities sooner. The Acumed Acu-Sinch Knotless Mini was designed in conjunction with Drs. David Ruch, Jerry Huang, and Ryan Garcia as an alternative SBS to stabilize and suspend the thumb metacarpal following trapeziectomy. Innovative drill design incorporates a recession element that maintains the suspension and allows the Acu-Sinch Knotless Mini device to pass along the drill track. Once deployed, the unique design employs a simple method to tighten and sinch the suture material without bothersome suture knots.