Current Innovations in Wrist Arthroscopy

Hand and Wrist Institute, Torrance, CA 90503, USA.
The Journal of hand surgery (Impact Factor: 1.66). 09/2012; 37(9):1932-41. DOI: 10.1016/j.jhsa.2012.06.028
Source: PubMed

ABSTRACT It has become clear that the stability of the scapholunate joint does not depend wholly on the scapholunate interosseous ligament, but rather on both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and should be treated with tissue-specific repairs, which may partly explain why one procedure cannot successfully restore joint stability in every case. Wrist arthroscopy has a pivotal role in both the assessment and treatment of the scapholunate ligament complex derangements. Tears of the foveal attachment of the triangular fibrocartilaginous complex can be an underdiagnosed cause of distal radioulnar joint instability, because the foveal fibers cannot be visualized using the standard radiocarpal arthroscopy portals. Distal radioulnar joint arthroscopy allows for direct visualization and assessment of these fibers, which in turn has spawned a number of open and arthroscopic repair methods. Wrist arthroscopy has gained wider acceptance as a method to fine-tune articular reduction during open and percutaneous fixation of distal radius fractures, and simplifies intra-articular osteotomies for malunion. It can facilitate percutaneous bone grafting of scaphoid nonunions and has a role in the diagnosis and treatment of associated soft tissue lesions. These and other recent developments will be discussed in the following article.

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    ABSTRACT: INTRODUCTION: The reproducibility of diagnoses based on photo documents in wrist arthroscopies is limited and is expected to improve through the addition of video documents. AIM: The purpose of this study was to determine the effect of additional video documentation to photo documentation on intra- and interobserver reliability in wrist arthroscopies. MATERIALS AND METHODS: Sixty consecutive arthroscopies were documented by photographs of at least eight standard views and videos of the radiocarpal and midcarpal joints. After 3 months, the photographs and then the photographs together with the videos were reevaluated by the surgeon and by two hand surgeons to determine intra- and interobserver reliability. Percentage agreement and kappa coefficients were calculated. RESULTS: Using videos along with the photographs did not improve reproducibility in general. The assessments of the cartilage status were even worse. Some of the videos were criticized as being too short to allow adequate assessment of the cartilage. Lesions of the TFCC as well as its tension were assessed notably better by the videos, whereas assessment of SL and LT ligaments was not improved by the videos. Intraobserver reliability was better than interobserver reliability. CONCLUSION: As long as videos do not meet further quality criteria, they are not able to improve reliability in general. Nevertheless, videos should be used for documentation of the TFCC.
    Archives of Orthopaedic and Trauma Surgery 12/2012; DOI:10.1007/s00402-012-1670-9 · 1.36 Impact Factor
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    ABSTRACT: The purpose of this retrospective study was to examine the sensitivity and specificity of preoperatively performed MRI of the wrist in identifying tears of the scapholunate ligament. Additionally, these findings were then compared with findings from a subsequently performed -arthroscopy of the wrist.The study was based on the MRI records of 401 patients who received MRI examinations between January 2004 and April 2012 in the context of ulnar-sided wrist pain. Subsequently, all patients received an arthroscopy of the wrist. The study included 218 male and 183 female patients with an average age of 42.4±14.3 years (range 12-84 years). The MRI examinations were conducted in various techniques and with various sequences. The MRI findings were evaluated by 88 experienced radiologists. The arthroscopies were performed by 16 experienced hand-surgeons who had seen the MRI results prior to the surgical intervention. -Arthroscopic findings were compared with MRI records and used as the benchmark.Only 31 of 98 arthroscopically verified cases of a torn scapholunate ligament could be identified in an MRI examination. In contrast, MRI could correctly diagnose an intact ligament in 269 out of 276 arthroscopically verified cases. When compared with arthroscopy MRI sensitivity and specificity were 32% and 98%, respectively. In 91 out of 401 MRI examinations the use of a dedicated surface coil was recorded. In 66 out of 401 MRI examinations the use of contrast medium was documented. MRI specificity slightly improved upon use of contrast medium.The comparison of MRI vs. arthroscopic sensitivity and specificity in the detection of scapholunate tears on a sufficiently large group of patients showed MRI to be a reliable method in excluding scapholunate ligament tears. Outside of clinical study conditions, however, it was found to be an unsuitable method in identifying and classifying scapholunate ligament tears. The high MRI sensitivity found by other studies could not be confirmed in our study.
    Handchirurgie · Mikrochirurgie · Plastische Chirurgie 02/2013; 45(1):26-32. DOI:10.1055/s-0033-1333689 · 0.54 Impact Factor
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    ABSTRACT: Many studies in literature have supported the role of wrist arthroscopy as an adjunct to the stable fixation of unstable intraarticular distal radial fractures. This article focuses on the surgical technique, indications, advantages, and results using wrist arthroscopy to assess articular reduction and evaluates the treatment of carpal ligament injuries and triangular fibrocartilage complex (TFCC) injuries in conjunction with the stable fixation of distal radial fractures. We retrospectively evaluated 27 patients (16 males and 11 females), who underwent stable fixation of intraarticular distal radial fractures with arthroscopic evaluation of the articular reduction and repair of associated carpal injuries. As per the AO classification, they were 9 C 1, 12 C2, 2 C3, 3 B 1, and 1 B2 fractures. The final results were evaluated by modified Mayo wrist scoring system. The average age was 41 years (range: 18-68 years). The average followup was of 26 months (range 24-52 months). Five patients needed modification of the reduction and fixation after arthroscopic joint evaluation. Associated ligament lesions found during the wrist arthroscopy were TFCC tears (n=17), scapholunate ligament injury (n=8), and luno-triquetral ligament injury (n=1). Five patients had combined injuries i.e. included TFCC tear, scapholunate and/or lunotriquetral ligament tear. There were 20 excellent, 3 good, and 4 fair results using this score. The radiocarpal and mid carpal arthroscopy is a useful adjunct to stable fixation of distal radial fractures.
    Indian Journal of Orthopaedics 03/2013; 47(3):288-294. DOI:10.4103/0019-5413.109872 · 0.62 Impact Factor