How to Perform a Complete Arthroscopic Assessment of the Scapholunate Joint Complex.

Scapholunate instability can result in debilitating pain, dysfunction, and secondary arthritis. Diagnosis is primarily based on a combination of clinical and radiological parameters. However, wrist arthroscopy is regarded as the gold standard for definitive confirmation to identify the extent of a scapholunate instability, with specific attention to the integrity of the extrinsic ligamentous system, which is probably more important than the intrinsic ligament.

Round table discussion. The management of proximal scaphoid nonunion.

The management of scaphoid nonunion, although relatively common, continues to pose challenges, especially if complicated by avascular necrosis of the proximal pole, humpback or dorsal intercalated segment instability deformities, and early scaphoid nonunion advanced collapse. In this round table article, four surgeons were asked to answer key questions on a clinical example of a proximal scaphoid nonunion to outline their approach and rationale in their preferred treatment choices. The current panel of experts leans towards arthroscopic methods of treatment and most agree that arthroscopic bone grafting has become an important and revolutionary treatment option, which has yielded excellent results.

Arthroscopic suture in the management of palmar midcarpal instability.

Aims: Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing.

Arthroscopic management of scapholunate complex injuries associated with distal radius fractures.

Scapholunate complex injuries are the most frequent lesions associated with distal radius fractures and the treatment algorithm according to the stage of the instability remains controversial. However, there is an admitted consensus around the necessary treatment of the associated high-grade instabilities. They occur frequently in young patients after high energy trauma, and not treated, they can lead to chronic wrist pain and eventually to scapholunate advanced collapse.

Interdisciplinary consensus statements on imaging of DRUJ instability and TFCC injuries.

Objectives: The purpose of this agreement was to establish evidence-based consensus statements on imaging of distal radioulnar joint (DRUJ) instability and triangular fibrocartilage complex (TFCC) injuries by an expert group using the Delphi technique.

Methods: Nineteen hand surgeons developed a preliminary list of questions on DRUJ instability and TFCC injuries. Radiologists created statements based on the literature and the authors' clinical experience.

Surgical Technique: Wide Arthroscopic Dorsal Capsuloligamentous Repair for Advanced Scapholunate Instability.

In the most advanced cases of scapholunate instability with dynamic or static signs, classical arthroscopic repair seems impossible. Ligamentoplasties or open surgery procedures are technically demanding, hampered by significant operative complications and often stiffening. Therapeutic simplification is therefore necessary for the management of these complex cases of advanced scapholunate instability.

Wide arthroscopic dorsal capsuloligamentous repair in patients with severe scapholunate instability.

A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability.

Arthroscopic Radiocarpal Tendinous Inter-Position for Grade 2 Scapholunate Advanced Collapse - Surgical Technique.

Grade 2 scapholunate advanced collapse (SLAC 2) can be treated by proximal row carpectomy with satisfactory results. However, this method is invasive and can limit function. The senior author had proposed an arthroscopic alternative with tendon interposition between the radius and proximal carpal row (arthroscopic interposition tendon arthroplasty [AITA]).

Arthroscopic Midcarpal Tendon Interposition: A New Technique for Capitolunate Constraints.

Conflicts of the capitolunate, causing midcarpal pain from friction can be isolated (e.g., avascular necrosis of the proximal pole of the capitate [AVNC], palmar midcarpal instability [PMCI]) or form part of a framework of more complex osteoarthritis phenomena (e.

History of Wrist Arthroscopy.

Wrist arthroscopy has a rich history, drawing on contributions from around the world. Its foundation was laid in Japan with Kenji Takagi and Masaki Watanabe, who developed the arthroscope and the techniques for arthroscopy. Across several decades they advanced the optic and lighting technology, allowing the miniaturization which made wrist arthroscopy technologically feasible.

Arthroscopic Bone Graft for Intraosseous Lunate Bone Ganglion.

Intraosseous lunate bone ganglia (ILBG) are known to be a cause of chronic wrist pain and disability. Standard treatment consists of curettage and autologous bone grafting. Open procedures have shown good results with few recurrences, but with frequent stiffness or persistent pain.

Arthroscopic Repair of the Dorsal Intercarpal Ligament Detachment from the Scaphoid.

 The dorsal intercarpal ligament, whose role in dorsal stability of the wrist has been shown, can be harmed in case of injury to the dorsal scapholunate complex. However, dorsal intercarpal ligament injury also seems to exist isolated posttraumatic forms of dorsal intercarpal ligament rupture, much rarer, through bony avulsion on its scaphoid insertion. The authors report the first description of this lesion, and propose a technique for arthroscopic repair.

Interdisciplinary consensus statements on imaging of scapholunate joint instability.

Objectives: The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.

Methods: Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience.

Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques.

The management of scapholunate injuries and dissociation remains debatable. Traditional methods of fixation had centred around open procedures, but advances in wrist arthroscopic techniques has redefined both major anatomical findings and operative approaches. This article challenges two main existing dogmas: first, the anatomy of the scapholunate ligament and second, the management of these injuries.

Role of wrist arthroscopy in scapholunate dissociation.

Scapholunate ligament tear is most frequently encountered in the aftermath of trauma in supination and extension of the wrist. It generates chronic instability, leading to osteoarthritis. It may be associated with fracture of the distal epiphysis of the radius or of the scaphoid.

Arthroscopic Interposition Tendon Arthroplasty for Stage 2 Scapholunate Advanced Collapse.

Purpose: To report and analyze the functional outcomes of arthroscopic interposition tendon arthroplasty (AITA) in stage 2 scapholunate advanced collapse (SLAC).

Methods: Sixteen patients with stage 2 SLAC who underwent AITA between 2009 and 2014 with a minimum of 24-month follow-up were retrospectively evaluated. Medical records were assessed for preoperative and postoperative range of motions, grip strength, visual analog scale, disabilities of the arm, shoulder, and hand (DASH) score, scapholunate angle, and scaphoid fossa-to-scaphoid space.

Treatment of the scaphoid humpback deformity - is correction of the dorsal intercalated segment instability deformity critical?

Treatment of scaphoid fractures has been focused mainly on achieving union, with less attention to restoring normal scaphoid shape and orientation. Malalignment of one carpal bone will disrupt the kinetics of the entire wrist. The dorsal intercalated segment instability deformity associated with scaphoid waist nonunion is a nondissociative form of carpal instability.

Arthroscopic Management of Dorsal and Volar Wrist Ganglion.

Dorsal and volar wrist ganglions are benign tumors; most of them are asymptomatic. They can disappear spontaneously. Arthroscopic resection can be performed for pain or cosmetic concern.