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Margulies IG, Xu H, Gopman JM, Freeman MD, Dayan E, Taub PJ, Melamed E. Narrative Review of Ligamentous Wrist Injuries. J Hand Microsurg 2021; 13:55-64. [PMID: 33867762 PMCID: PMC8041499 DOI: 10.1055/s-0041-1724224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.
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Affiliation(s)
- Ilana G Margulies
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Hope Xu
- Section of Plastic Surgery, University of Chicago, Chicago, Illinois, United States
| | - Jared M Gopman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Matthew D Freeman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Peter J Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eitan Melamed
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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Özkan S, Mudgal CS, Jupiter JB, Bloemers FW, Chen NC. Scapholunate Diastasis in Distal Radius Fractures: Fracture Pattern Analysis on CT Scans. J Wrist Surg 2020; 9:338-344. [PMID: 32760613 PMCID: PMC7395844 DOI: 10.1055/s-0040-1712505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
Objectives Our understanding of distal radius fractures with concomitant scapholunate (SL) diastasis primarily comes from plain radiographs and arthroscopy. The clinical implications of SL diastasis are not clear. The aim of this study is to describe fracture characteristics of distal radius fractures on computed tomography (CT) scans in patients with distal radius fractures and static SL diastasis. Methods We queried our institutional databases to identify patients who were treated for a distal radius fracture, had a CT scan with a wrist-protocol, and static SL diastasis on their CT scan. Our final cohort consisted of 26 patients. We then collected data on their demographics, injury, treatment, evaluated injury patterns, and measured radiographic SL characteristics. Our study cohort consisted of 11 men (42%) and almost half of our cohort ( n = 12; 46%) had a high-energy mechanism of injury. The majority of the patients ( n = 20; 77%) had operative treatment for their distal radius fracture and two patients (7.7%) had operative treatment of their SL injury. Results The mean SL distance was 3.5 ± 1.1 mm. Twenty patients (77%) had an intra-articular fracture. In these patients, we observed three patterns: (1) scaphoid facet impaction; (2) lunate facet impaction; and (3) no relative impaction. We observed other injury elements including rotation of the radial styloid relative to the lunate facet and partial carpal subluxations. Conclusion Static SL dissociation in the setting of distal radius fractures may be an indication of a complex injury of the distal radius, which may not be directly apparent on plain radiography. If these radiographs do not demonstrate impaction of the lunate or scaphoid facet, a CT scan may be warranted to have a more detailed view of the articular surface. Level of Evidence This is a Level III, diagnostic study.
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Affiliation(s)
- Sezai Özkan
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
- Department of Trauma Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Chaitanya S. Mudgal
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
| | - Frank W. Bloemers
- Department of Trauma Surgery, VU University Medical Center, VU University, Amsterdam, The Netherlands
| | - Neal C. Chen
- Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Boston, Massachusetts
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Gire JD, Yao J. Surgical Techniques for the Treatment of Acute Carpal Ligament Injuries in the Athlete. Clin Sports Med 2020; 39:313-337. [PMID: 32115087 DOI: 10.1016/j.csm.2019.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The treatment of athletes with carpal ligament injuries provides many challenges. Our initial goals remain to make a timely and accurate diagnosis, provide treatment options, and create an environment for shared decision making. To optimize outcomes and facilitate return to play, early surgical intervention may be warranted. This article reviews common carpal ligament injury patterns in the athlete with a focus on both classic and newer surgical techniques.
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Affiliation(s)
- Jacob D Gire
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA
| | - Jeffrey Yao
- Robert A. Chase Hand and Upper Limb Center, Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway Street, MC 6342, Redwood City, CA 94063, USA.
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Matson AP, Dekker TJ, Lampley AJ, Richard MJ, Leversedge FJ, Ruch DS. Diagnosis and Arthroscopic Management of Dorsal Wrist Capsular Impingement. J Hand Surg Am 2017; 42:e167-e174. [PMID: 28259281 DOI: 10.1016/j.jhsa.2016.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Dorsal wrist capsular impingement (DWCI) is characterized by pain attributable to impingement of dorsal capsular tissue during wrist extension. The diagnostic criteria and management algorithm for this condition have not been well established. The aims of our study were (1) to retrospectively review the clinical presentation and arthroscopic findings of patients treated surgically for DWCI and (2) to evaluate the outcomes of arthroscopic debridement for this condition. METHODS A total of 19 patients were treated with arthroscopic debridement for isolated DWCI from 2006 to 2015 by two surgeons (M.J.R. and D.S.R.) at a single institution. A chart review was performed to gather information on clinical presentation, radiological findings, operative details, and outcomes including numeric pain scale rating, range of motion, Mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand score. Patients were contacted at the time of the study for final telephone follow-up. RESULTS Symptoms were present for a median of 12.5 months (range, 3.5-124.4 mo) prior to surgical intervention, and all patients had pain localized to the dorsal and central wrist with passive terminal wrist extension (100%; 19 of 19). We obtained magnetic resonance imaging in 66% of patients (12 of 19). Diagnostic arthroscopy yielded evidence of infolded, redundant dorsal capsular tissue in all cases (19 of 19), and there was no evidence of concomitant wrist pathology. Compared with preoperative values, postoperative improvements were seen in average numeric pain scale rating (6.0-1.9), Quick Disabilities of the Arm, Shoulder, and Hand score (45.8-4.8), and Mayo wrist score (50.0-87.8). These improvements were sustained at 41.6 months after surgery (range, 11.9-73.8 months). One complication of superficial cellulitis occurred. CONCLUSIONS Dorsal wrist capsular impingement is a clinical diagnosis; magnetic resonance imaging may be helpful in evaluating for other pathologies. Diagnostic arthroscopy yields evidence of redundant dorsal capsular tissue, and arthroscopic debridement of this tissue offers a safe and effective treatment to improve pain and functional scores. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Andrew P Matson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Travis J Dekker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Alexander J Lampley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Fraser J Leversedge
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
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Fontès D. [Pathology of the triangular fibrocartilaginous complex in distal radius fractures]. HAND SURGERY & REHABILITATION 2016; 35S:S60-S68. [PMID: 27890214 DOI: 10.1016/j.hansur.2016.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 01/23/2016] [Indexed: 10/20/2022]
Abstract
Distal radius fracture is actually quite rarely isolated and triangular fibrocartilaginous complex (TFCC) is often involved with the same mechanism of injury. A contemporary management of the treatment of the initial fracture is ideal and so benefits from a routine arthroscopic management. Nevertheless, in the absence of diagnosis and therefore early treatment, the symptoms may be located at the ulnar crossroads and justify specific treatment of TFCC. It is generally conducted after an accurate arthroscopic lesion classification guiding a procedure, depending on the lesion vascularization as well as its possible destabilization potential (debridement, capsular suture or foveal reattachment). Unfortunately, too often the radius fracture is insufficiently stabilized by an inadequate fixation process or inappropriate orthopedic management with a positive ulnar variance consequence and an ulnar plus syndrome. A "wafer procedure" may then sometimes be proposed if a shortening of less than 3mm is needed and that the distal radio-ulnar joint is not too disorganized.
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Affiliation(s)
- D Fontès
- Clinique du sport, 36, boulevard Saint-Marcel, 75005 Paris, France.
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Lindau TR. The role of arthroscopy in carpal instability. J Hand Surg Eur Vol 2016; 41:35-47. [PMID: 26581604 DOI: 10.1177/1753193415616276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/15/2015] [Indexed: 02/03/2023]
Abstract
Carpal instability is predominantly caused by trauma and presents as a painful wrist with signs and symptoms of weakness, clicking, clunking and a sense of giving way. Wrist arthroscopy is widely regarded as the 'gold standard' in diagnosing and understanding carpal instability. This article is based on an extensive literature search to evaluate the evidence behind the use of wrist arthroscopy in the assessment and management of these patients. There is convincing evidence supporting the role of arthroscopy in diagnosis and assessment of factors involved in the development of carpal instability, but weak evidence for the effectiveness of arthroscopic techniques in the actual treatment of this condition. The article reviews mechanisms behind, and the role for arthroscopy in the management of scapholunate, lunotriquetral, midcarpal and radiocarpal instability. It also presents how the author incorporates the 'evidence-base' into an 'experience-based' clinical practice.
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Abstract
Advances in optical technology, instrumentation and implants now enable arthroscopic surgery to be performed on all large joints and most small joints of the limbs. Arthroscopic techniques are usually a development of surgical procedures previously performed through a large open incision, although the critical element of each procedure (for example removal of a torn meniscus) usually remains unchanged. The smaller size of incisions and reduction in tissue damage associated with arthroscopic surgery can reduce morbidity and complications. Therapeutic arthroscopy now encompasses excision, reconstruction and replacement of damaged or abnormal tissue. Improvements in the accuracy of MRI, CT and high-definition ultrasonography have limited the use of diagnostic arthroscopy to rare indications, but in the past 10 years the rates of some arthroscopic surgeries have increased by over 7-fold. Considerable variation in the type and utilization of arthroscopic procedures exists in practice, partly explained by the slow diffusion of new techniques and technology, but also by differences in clinician and patient beliefs and expectations. This Review reflects on both the success of arthroscopy and the general lack of evidence-based assessment of the efficacy and cost-effectiveness of arthroscopic procedures-a clear sign that more clinical trials in this field are required.
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Binder AC, Kerfant N, Wahegaonkar AL, Tandara AA, Mathoulin CL. Dorsal wrist capsular tears in association with scapholunate instability: results of an arthroscopic dorsal capsuloplasty. J Wrist Surg 2013; 2:160-167. [PMID: 24436810 PMCID: PMC3699268 DOI: 10.1055/s-0032-1333426] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose The purpose of this study is to report the association of dorsal wrist capsular avulsion with scapholunate ligament instability and to evaluate the results of an arthroscopy-assisted repair. Methods We retrospectively reviewed 10 patients with a mean age of 39.1 years suffering from chronic dorsal wrist pain. They underwent a wrist arthroscopy with an evaluation of the scapholunate ligament complex from the radiocarpal and midcarpal compartments. An avulsion of the dorsal intercarpal ligament (DICL) from the scapholunate interosseous ligament (SLIL) was visible from the radiocarpal compartment in all cases, while the SLIL was intact. The DICL tear was repaired with an arthroscopy-assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by the QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, by the Visual Analog Scale (VAS) for pain, and by a clinical and radiological examination. Results Preoperatively, all patients had reduced flexion and radial deviation of the affected wrist. On the lateral radiograph, 5 of the 10 patients showed an increase of the scapholunate angle (60 to 85°). The scapholunate instability was graded as Messina-European Wrist Arthroscopy Society (EWAS) II in five cases and as grade IIIB in five cases. A tear of the ulnar part of the triangular fibrocartilage complex (TFCC) was found in seven cases. At a mean followup of 16 months, the wrist range of motion (ROM), the grip strength, the QuickDASH, and the VAS of pain improved significatively. The scapholunate angle was normalized in all cases. Discussion Isolated tears of the DICL at its insertion from the dorsal part of the SLIL can be associated with scapholunate instability in the absence of an injury to the SLIL. The diagnosis is made arthroscopically. The arthroscopic dorsal capsuloplasty is a minimally invasive technique that provides short-term satisfactory results. Further studies are needed to determine whether repair of the DICL tear could prevent secondary destabilization of the scapholunate ligament complex. Level of evidence IV (case series) Diagnosis.
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Affiliation(s)
| | - Nathalie Kerfant
- Service de Chirurgie Orthopédique et Chirurgie Plastique, SOS mains, CHU La Cavale Blanche, Brest, France
| | - Abhijeet L. Wahegaonkar
- Hand and Microvascular Reconstructive Surgery–Hand Surgery Associates, Pune, India
- Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
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Messina JC, Van Overstraeten L, Luchetti R, Fairplay T, Mathoulin CL. The EWAS Classification of Scapholunate Tears: An Anatomical Arthroscopic Study. J Wrist Surg 2013; 2:105-9. [PMID: 24436801 PMCID: PMC3699273 DOI: 10.1055/s-0033-1345265] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Treatment of scapho-lunate (SL) injuries is still a challenge for the surgeon, especially in chronic cases. The aim of the study isto experimentally cut, specific portions of scapholunate ligament and extrinsic ligaments and check their corresponding arthroscopic finding in order to understand the pathogenesis and develop a new classification system which is an evolution of the present arthroscopic classifications. Materials and Methods Thirteen cadaver wrists were studied under arthroscopy. Different portions of the scapho-lunate ligament were subsequently sectioned. In group A the sectioning sequence was: anterior SLIOL, RSC, LRL, SLIOL's proximal and posterior, DIC, DRC ligament and ST ligaments (8 cases). In group B it was: SLIOL's posterior and proximal, DIC, SLIOL's anterior, LRL, RSCL, DRC, ST ligaments (5 cases). The anatomo-pathological findings after each sectioning were correlated to the classification system proposed (Table 1). Results In group A, stage 3A was obtained when SL ligament's volar and intermediate portion and/ or SC/LRL ligaments were sectioned. A stage 3C was obtained when section of posterior SLIOL was sectioned as well. A stage IV when the DIC was also sectioned. In group B a stage 3B was obtained by cutting intermediate, posterior portion of the SLIOL ligament and DIC. A stage 3C was obtained when the anterior part of the SLIOL was also sectioned. In all cases, sectioning of the SLIOL lead to a stage 3C only if associated with sectioning of at least one of the extrinsic stabilizers (DIC or SC/LRL). Sectioning of DIC and SC ligament, in addition to SLIOL led to an arthroscopic stage IV. When ST, DRC and TH ligaments were also sectioned significant radiological signs appeared (stage V). Conclusions This study helps us to understand the anatomo-pathological scapho-lunate lesions in their different stages of partial lesions. Commonly called scapho-lunate lesions are complex, involving also extrinsic ligaments.
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Affiliation(s)
- Jane C. Messina
- Hand Surgery Unit, Gaetano Pini Orthopaedic Institute, Milano, Italy
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Abstract
Anatomic and biomechanical research of the wrist has yielded a substantial amount of information that improves our basic knowledge of carpal morphology and function of the wrist and provides information to better assess and improve treatment(s) for various problems of the wrist joint. A precise knowledge of the anatomy and biomechanics of the wrist is useful not only for diagnosis of traumatic ligamentous injuries or degenerative change of the wrist joint but also for treatment for wrist dysfunction.
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Affiliation(s)
- Yasumu Kijima
- Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Japan
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Wollstein R, Kirk Watson H, Wear-Maggitti K, Schmidt S, Carlson L. Surgical technique for the treatment of radial wrist pain. ACTA ACUST UNITED AC 2009; 42:149-52. [DOI: 10.1080/02844310801987685] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Slutsky DJ. Incidence of dorsal radiocarpal ligament tears in the presence of other intercarpal derangements. Arthroscopy 2008; 24:526-33. [PMID: 18442684 DOI: 10.1016/j.arthro.2007.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 12/07/2007] [Accepted: 12/07/2007] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to examine the incidence of dorsal radiocarpal ligament (DRCL) tears in patients who underwent wrist arthroscopy for chronic pain. METHODS A chart review was performed of 64 patients who underwent diagnostic wrist arthroscopy for wrist pain. Interosseous ligament instability/tears were graded according to the Geissler classification. Tears of the triangular fibrocartilage complex (TFCC) and other intracarpal pathology were documented. Any DRCL tears were noted. RESULTS The average duration of wrist pain before arthroscopy was 20 months. There were 35 of 64 patients with DRCL tears. The average duration of wrist pain before treatment was 20 months (range, 4 to 60 months). There were 5 patients who had an isolated DRCL tear. Thirteen patients in this series had a scapholunate interosseous ligament (SLIL) derangement; 7 of 13 also had a DRCL tear. Seven patients had a lunotriquetral interosseous ligament (LTIL) derangement; 2 of 7 also had a DRCL tear. Two patients had a capitohamate ligament tear; 1 of these patients also had a DRCL tear. There were 7 patients with a solitary TFCC tear; 6 of 7 were in association with a DRCL tear. One patient had a chronic ulnar styloid nonunion and a DRCL tear. Two or more lesions were present in 23 patients; DRCL tears were present in 12 of 23 patients. Three patients had generalized arthrofibrosis; 1 had a volar ganglion and 2 had a normal examination. None of these were associated with DRCL tears. CONCLUSIONS DRCL tears are commonly seen with injuries to the SLIL, the LTIL, and the TFCC. Isolated DRCL tears should be treated with an arthroscopic repair. DRCL repairs in the presence of other intracarpal pathologies requires further study. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- David J Slutsky
- Department of Orthopedics, Harbor-UCLA Medical Center, Los Angeles, California, USA.
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Chloros GD, Wiesler ER, Poehling GG. Current concepts in wrist arthroscopy. Arthroscopy 2008; 24:343-54. [PMID: 18308188 DOI: 10.1016/j.arthro.2007.10.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Revised: 10/25/2007] [Accepted: 10/26/2007] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to review the recent literature on arthroscopic treatment of distal radius fractures (DRFs), triangular fibrocartilage complex injuries, intercarpal ligament injuries, and ganglion cysts, including the use of electrothermal devices. A major advantage of arthroscopy in the treatment of DRFs is the accurate assessment of the status of the articular surfaces and the detection of concomitant injuries. Nonrandomized studies of arthroscopically assisted reduction of DRFs show satisfactory results, but there is only 1 prospective randomized study showing the benefits of arthroscopy compared with open reduction-internal fixation. Wrist arthroscopy plays an important role as part of the treatment for DRFs; however, the treatment for each practitioner and each patient needs to be individualized. Wrist arthroscopy is the gold standard in the diagnosis and treatment of triangular fibrocartilage complex injuries. Type 1A injuries may be successfully treated with debridement, whereas the repair of type 1B, 1C, and 1D injuries gives satisfactory results. For type 2 injuries, the arthroscopic wafer procedure is equally effective as ulnar shortening osteotomy but is associated with fewer complications in the ulnar positive wrist. With interosseous ligament injuries, arthroscopic visualization provides critical diagnostic value. Debridement and pinning in the acute setting of complete ligament tears are promising and proven. In the chronic patient, arthroscopy can guide reconstructive options based on cartilage integrity. The preliminary results of wrist arthroscopy using electrothermal devices are encouraging; however, complications have been reported, and therefore, their use is controversial. In dorsal wrist ganglia, arthroscopy has shown excellent results, a lower rate of recurrence, and no incidence of scapholunate interosseous ligament instability compared with open ganglionectomy. Arthroscopy in the treatment of volar wrist ganglia has yielded encouraging preliminary results; however, further studies are warranted to evaluate the safety and efficacy of arthroscopy.
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Affiliation(s)
- George D Chloros
- Department of Orthopaedic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
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Abstract
PURPOSE OF REVIEW To examine recent trends in the use of arthroscopic surgical techniques to address musculoskeletal problems. The review is particularly timely given the rapidly expanding range of indications for diagnostic and therapeutic arthroscopic procedures involving virtually every peripheral joint. RECENT FINDINGS We focus on arthroscopic approaches to problems of the hip, wrist, elbow and ankle. Hip arthroscopy is permitting novel, minimally invasive approaches to the management of femoral acetabular impingement, labral tears, loose bodies and chondral lesions. Wrist arthroscopy has provided novel approaches to ligament tears, synovitis and fractures. Ankle arthroscopy has been especially helpful with soft tissue impingement syndromes, synovitis and fracture. Elbow arthroscopy has been especially helpful in the management of synovitis and osteoarthritis due to osteophytosis. Complications of arthroscopic procedures occur very rarely. Virtually all the literature on arthroscopy outcomes comes from small uncontrolled studies. SUMMARY Arthroscopy provides a safe alternative to arthrotomy in the management of a wide range of clinical problems. The generally weak designs of studies performed to date compromises the strength of recommendations that can be made about the role of these procedures in clinical practice.
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Affiliation(s)
- Jeffrey N Katz
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Affiliation(s)
- R Shane Tubbs
- Department of Cell Biology, University of Alabama at Birmingham, 35233, USA.
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