scholarly journals WRIST ARTHROSCOPY: BASIC TIPS FOR DRY ARTHROSCOPIC EXPLORATION

2017 ◽  
Vol 25 (6) ◽  
pp. 291-294
Author(s):  
HENRIQUE DE BARROS PINTO NETTO ◽  
SUZILAINE RAMOS DE OLIVEIRA ◽  
FLAVIA CURVO PEREIRA ◽  
NILTON MAZZER
Keyword(s):  
Soft Tissues ◽  
Synovial Cyst ◽  
Ligament Injury ◽  
Wrist Arthroscopy ◽  
Early Recovery ◽  
Level Of Evidence ◽  
Injury Repair ◽  
Scapholunate Ligament Injury ◽  
Classical Technique ◽  
Triangular Fibrocartilage

ABSTRACT Objective: This article provides details and tips on the dry arthroscopic technique, based on our experience and its clinical applications. Method: The technique was applied to 65 patients (33 men and 32 women) aged between 20 and 62 years (average of 35.4 years) for treating: synovial cyst resection, scapholunate ligament injury repair, ulnocarpal impact correction, triangular fibrocartilage injury repair, and assisted reduction of distal radius fractures. Results: A minimally invasive intra-articular evaluation has been observed as a benefit, with low infection rate, small scars, and high rates of early recovery, without affecting intra-articular fluid use, reducing the risk of compartment syndrome and infiltrated soft tissues, in the case of need for associated open surgery. As for the difficulties, we report the surgeon’s view, which is commonly prevented by optical blurring or debris that hit the lens, and the need for radiofrequency care, since the heat generated is dissipated with greater difficulty than in the classical technique. Conclusion: Dry arthroscopy emerges as an effective choice to treat wrist pathologies, however, deep knowledge and ease with the classical technique, as well as a learning curve, are key to obtain a good outcome. Level of Evidence V, Expert Opinion.

Comparison between MRI and Arthroscopy of the Wrist for the Assessment of Posttraumatic Lesions of Intrinsic Ligaments and the Triangular Fibrocartilage Complex

2021 ◽  
Author(s):  
Sergio De Santis ◽  
Roberto Cozzolino ◽  
Riccardo Luchetti ◽  
Lucia Cazzoletti
Keyword(s):  
Triangular Fibrocartilage Complex ◽  
Ligament Injury ◽  
Wrist Arthroscopy ◽  
Mri Imaging ◽  
Likelihood Ratios ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Predictive Values ◽  
Arthroscopic Findings ◽  
Triangular Fibrocartilage

Abstract Background Magnetic resonance imaging (MRI) has been considered the most appropriate examination for wrist ligament injuries diagnosis, but it frequently fails to assess the intrinsic ligament lesion. Therefore, wrist arthroscopy is required to enhance and define the diagnosis. Purpose We compare the MRI imaging with wrist arthroscopy for intrinsic wrist ligaments (scapholunate [SL] and lunotriquetral [LT]) and triangular fibrocartilage complex (TFCC) injuries detection. Patients and Methods From 2007 to 2014, 532 patients affected by suspected SL, LT, and TFCC posttraumatic ligament injury have been investigated by 1.5-Tesla MRI and wrist arthroscopy. Inclusion and exclusion criteria were adopted. Only for SL ligament injury, the arthroscopic findings of complete (stage IV) and partial (stages I–III) SL ligament injury were compared with MRI findings. Statistical analysis, including sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and the diagnostic odds ratio, was used to compare MRI with arthroscopic findings. Results A total of 146 patients were accepted in the study. In 68 cases of arthroscopic SL ligament lesion, MRI confirmed the diagnosis only in 50% of the cases. In partial SL lesions, MRI was positive in 24.3% and in complete SL lesions, MRI was positive in 80.6% of the cases. In 10 cases of arthroscopic LT ligament lesion, MRI was positive in 30.0% of the cases. In 33 patients with arthroscopic TFCC lesion, MRI was positive in 66.7% of the cases. Conclusion 1.5-T MRI demonstrated to fail in confirming the lesion of SL, LP, and TFCC ligaments respectively in 50, 70, and 33.3% of the cases positive at arthroscopy. In complete SL ligament lesion, MRI reaches a higher sensitivity than in partial lesion. Arthroscopy remains the best method to demonstrate the ligament lesion and obtain more information regarding the extent and quality of the ligament damage. Level of Evidence This is a Level II, retrospective comparative study.

The correlation of initial radiographic characteristics of distal radius fractures and injuries of the triangular fibrocartilage complex

2016 ◽  
Vol 41 (5) ◽  
pp. 516-520 ◽  
Author(s):  
K. Kasapinova ◽  
V. Kamiloski
Keyword(s):  
Distal Radius Fracture ◽  
Distal Radius ◽  
Triangular Fibrocartilage Complex ◽  
Distal Radius Fractures ◽  
Radius Fracture ◽  
Wrist Arthroscopy ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage ◽  
A Prospective Study

Our purpose was to determine the correlation of initial radiographic parameters of a distal radius fracture with an injury of the triangular fibrocartilage complex. In a prospective study, 85 patients with surgically treated distal radius fractures were included. Wrist arthroscopy was used to identify and classify triangular fibrocartilage complex lesions. The initial radial length and angulation, dorsal angulation, ulnar variance and distal radioulnar distance were measured. Wrist arthroscopy identified a triangular fibrocartilage complex lesion in 45 patients. Statistical analysis did not identify a correlation with any single radiographic parameter of the distal radius fractures with the associated triangular fibrocartilage complex injuries. The initial radiograph of a distal radius fracture does not predict a triangular fibrocartilage complex injury. Level of evidence: III

Patients with triangular fibrocartilage complex injuries and distal radioulnar joint instability have reduced rotational torque in the forearm

2016 ◽  
Vol 41 (7) ◽  
pp. 732-738 ◽  
Author(s):  
J. K. Andersson ◽  
P. Axelsson ◽  
J. Strömberg ◽  
J. Karlsson ◽  
J. Fridén
Keyword(s):  
Joint Instability ◽  
Clinical Signs ◽  
Case Series ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Arthroscopy ◽  
Level Of Evidence ◽  
Independent Observer ◽  
Radioulnar Joint ◽  
Triangular Fibrocartilage

A total of 20 patients scheduled for wrist arthroscopy, all with clinical signs of rupture to the triangular fibrocartilage complex and distal radioulnar joint instability, were tested pre-operatively by an independent observer for strength of forearm rotation. During surgery, the intra-articular pathology was documented by photography and also subsequently individually analysed by another independent hand surgeon. Arthroscopy revealed a type 1-B injury to the triangular fibrocartilage complex in 18 of 20 patients. Inter-rater reliability between the operating surgeon and the independent reviewer showed absolute agreement in all but one patient (95%) in terms of the injury to the triangular fibrocartilage complex and its classification. The average pre-operative torque strength was 71% of the strength of the non-injured contralateral side in pronation and supination. Distal radioulnar joint instability with an arthroscopically verified injury to the triangular fibrocartilage complex is associated with a significant loss of both pronation and supination torque. Level of evidence: Case series, Level IV.

scholarly journals Significance of Scapholunate Gap Width as Measured by Probe from Midcarpal

2017 ◽  
Vol 06 (04) ◽  
pp. 316-324
Author(s):  
Holger Erne ◽  
Ute Strobl ◽  
Frank Unglaub ◽  
Christian Spies ◽  
Steffen Löw
Keyword(s):  
Hardware Removal ◽  
Ligament Injury ◽  
Dash Score ◽  
Level Of Evidence ◽  
Ulnar Impaction ◽  
Significant Difference ◽  
Triangular Fibrocartilage ◽  
Ulnar Impaction Syndrome ◽  
Probe Insertion ◽  
Gap Width

Background Geissler's classification is widely accepted in arthroscopic diagnostics of scapholunate (SL) ligament injury. Thereby, probe insertion into the SL gap from the midcarpal would indicate treatment necessity in patients with SL tear as seen from radiocarpal view. Purpose In this review, the SL gap width, examined by the probe from midcarpal, was arthroscopically assessed in patients with intact SL ligaments, who were treated for ulnar impaction syndrome. The review examined how often lax SL joints can be found in patients with no complaints with respect to the SL ligaments and in which the SL ligaments were proven to be intact from radiocarpal view. We suspected that probe insertion, as an indicator for a lax joint, does not affect the outcome in ulnar impaction treatment. Patients and Methods A total of 32 patients with clinically diagnosed ulnar impaction syndrome were arthroscopically treated by central resection and debridement of the triangular fibrocartilage; 8 patients underwent concurrent ulnar shortening, and 4 of them finally hardware removal. All patients were examined preoperatively as well as after 3, 6, and 12 months following arthroscopy, respectively, after ulnar shortening or hardware removal. Results In 14 patients, the probe could not, in 18 patients, the probe could be inserted into the SL gap. There was neither any significant difference in the improvement of pain, grip strength, Krimmer, or DASH score, nor for any of the radiographic angles between the two groups. Conclusion Laxity of the SL ligament allows the probe to be inserted into the SL gap from midcarpal in some patients. This finding, therefore, does not necessarily imply the necessity of treatment when there is partial rupture seen from radiocarpal view. Level of Evidence Level III, case–control study.

scholarly journals Radiographic Diagnosis of Scapholunate Diastasis in Distal Radius Fractures: Implications for Surgical Practice

2018 ◽  
Vol 07 (04) ◽  
pp. 312-318
Author(s):  
Sezai Özkan ◽  
Julian Korteweg ◽  
Frank Bloemers ◽  
Nicholas DiGiovanni ◽  
Chaitanya Mudgal
Keyword(s):  
Distal Radius ◽  
The United States ◽  
Distal Radius Fractures ◽  
Ligament Injury ◽  
Scapholunate Ligament ◽  
Radius Fractures ◽  
Level Of Evidence ◽  
Radiographic Diagnosis ◽  
Urban City ◽  
Scapholunate Ligament Injury

Background Radiographic diagnosis of scapholunate ligament injury (SLI) in the setting of distal radius fractures (DRFs) is challenging. It remains unclear to what extent radiographic diagnosis of SLI by a radiologist influences surgical decision-making regarding treatment of SLI. Purpose We aimed to (1) identify the number of times that concerns for the possibility of concurrent SLI in the setting of a DRF had been raised by the radiologists, (2) identify how often the radiologist's diagnosis was confirmed by the treating surgeon, and (3) how many of the patients with a radiographic concern for SLI by the radiologist received operative treatment for the SLI. Patients and Methods Based on Current Procedural Terminology codes, we identified 2,923 patients that were operatively treated for their DRF in 1 of 3 participating institutions in an urban city in the United States. We reviewed the medical charts of 654 patients who had a mention of scapholunate ligament (SL) distance in their radiography, surgery, or clinical notes. We then measured the SL distance and recorded patient, diagnosis, and treatment characteristics of all these patients. Results A total of 200 out of 2,923 patients (6.8%) received a radiological diagnosis of SLI. In seven of these patients (3.5%), the surgeon confirmed the diagnosis of the radiologist. Four patients (2%) had operative repair of their SLI. Conclusion Radiologists demonstrate a low threshold to identify SLI in the setting of DRFs, while the number of SLIs identified by the treating surgeon is a remarkably smaller number. Level of Evidence Level II, prognostic study.

scholarly journals Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

2021 ◽  
Vol 10 (11) ◽  
pp. 2363
Author(s):  
Florian Schachinger ◽  
Sebastian Farr
Keyword(s):  
Systematic Review ◽  
Return To Sport ◽  
Sports Participation ◽  
Triangular Fibrocartilage Complex ◽  
Wrist Pain ◽  
Arthroscopic Treatment ◽  
Wrist Arthroscopy ◽  
Cochrane Central Register ◽  
Level Of Evidence ◽  
Triangular Fibrocartilage

Introduction: Injury to the triangular fibrocartilage complex (TFCC) may cause chronic wrist pain and instability if left untreated. The current literature of adult cases suggests that arthroscopic treatment offers favorable outcomes and is associated with a low complication rate. This systematic review evaluated the outcomes of arthroscopic TFCC surgery in adolescents. Materials and Methods: A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cochrane Clinical Answers was conducted in May 2020. All studies reporting on (1) arthroscopic TFCC repair or debridement in (2) patients under the age of 19 years with (3) a minimum case number of four patients were extracted by two independent observers. The level of evidence of each study was assessed according to the Oxford Centre for Evidence-Based Medicine, and study quality was graded according to the Modified Coleman Methodology Score and the MINORS criteria. Clinical outcome scores, functional parameters, and any complications were reviewed. Results: The selected search terms initially resulted in a total of 986 possible articles. The authors eventually identified eight papers (all LoE IV) for inclusion in this systematic review. A total of 254 patients with verified TFCC tears and a mean age of 16 years (range, 7–19) received arthroscopic repair (162 patients, 67.1% of total) or debridement (77 patients, 29.7% of total). Arthroscopic treatment resulted in low pain levels, high patient satisfaction, and a fast return to sport. Complications overall were sparse and consisted mainly of persistent wrist pain (n = 31) and temporary paresthesia (n = 6) of the dorsal sensory branch of the ulnar nerve. Recurrent tears were sparse, with only four reported cases due to sports participation. Conclusion: Wrist arthroscopy is a reliable surgical option for treating TFCC tears in adolescents. The results obtained are comparable to those published in the literature. However, the variety of repair techniques and the low level of evidence across all included articles demand further prospective studies.

scholarly journals Bibliometric Analysis of the Top 100 Most Cited Articles on Wrist Arthroscopy

2021 ◽  
Author(s):  
Nevzat Gönder ◽  
Volkan Kılınçoğlu
Keyword(s):  
Hand Surgery ◽  
The United States ◽  
Diagnosis And Treatment ◽  
Wrist Arthroscopy ◽  
Level Of Evidence ◽  
The Past ◽  
Triangular Fibrocartilage ◽  
Number Of Publications ◽  
Randomised Controlled ◽  
Number Of Citations

Abstract Background: Over the past few decades, more articles have been published about wrist arthroscopy. The purpose of this study was to identify and analyze the 100 most cited articles about wrist arthroscopy.Methods: The 100 most cited articles were analyzed using the wrist arthroscopy as a keyword on the Web of Science database. Original articles, reviews, clinical trials, and cadaveric studies were included in the study. We recorded and analyzed the following information: Article title, first author, year of publication, journal of publication, the total number of citations, level of evidence, article language, country, institution, and the main topic of study. Results: The number of citations ranged from 35 to 180 (mean, 64.74). The total number of citations was 6,474. Among the articles examined, the most prolific country was the United States of America (USA). The Journal of Hand Surgery- American Volume was the journal with the most number of publications and the most cited articles. The main topics that were most analyzed and underlined were the diagnostic comparison of Magnetic resonanas imaging and arthroscopy and the diagnosis and treatment of triangular fibrocartilage complex.Conclusions: As a result, wrist arthroscopy continues to develop, and it is a subject that is open for new studies. More comprehensive and up-to-date randomised controlled studies comparing the benefit of wrist arthroscopy or open surgery for wrist pathologies will demonstrate the importance of arthroscopy in the diagnosis and treatment of problems related to this topic.

Mri Versus Arthroscopy in the Diagnosis of Scapholunate Ligament Injury

2001 ◽  
Vol 26 (1) ◽  
pp. 17-21 ◽  
Author(s):  
M. SCHÄDEL-HÖPFNER ◽  
J. IWINSKA-ZELDER ◽  
T. BRAUS ◽  
G. BÖHRINGER ◽  
K. J. KLOSE ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Correct Diagnosis ◽  
Conventional Technique ◽  
Ligament Injury ◽  
Wrist Arthroscopy ◽  
Scapholunate Ligament ◽  
Intravenous Contrast ◽  
Interosseous Ligament ◽  
Scapholunate Ligament Injury ◽  
Intravenous Contrast Medium

In a prospective study 103 patients with clinically or radiologically suspected tears of the scapholunate interosseous ligament were investigated with magnetic resonance imaging (MRI) and wrist arthroscopy. MRI was performed with the conventional technique in 72 cases and after intravenous injection of contrast medium in the remaining 31 patients. The correct diagnosis was made by MRI in 75% of cases and its overall sensitivity and specificity were 63% and 86% respectively. There was no statistical difference in the accuracy of MRI for acute or chronic tears and the use of intravenous contrast medium did not improve its accuracy. In conclusion, MRI is not recommended for the diagnosis of scapholunate ligament injury.

The rein-type arthroscopic capsular suture for triangular fibrocartilage complex foveal tears: midterm results for 90 patients

2021 ◽  
pp. 175319342110241
Author(s):  
I-Ning Lo ◽  
Kuan-Jung Chen ◽  
Tung-Fu Huang ◽  
Yi-Chao Huang
Keyword(s):  
Simple Procedure ◽  
Distal Radioulnar Joint ◽  
Triangular Fibrocartilage Complex ◽  
Joint Stability ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
High Satisfaction ◽  
Ultrasound Assessment ◽  
Triangular Fibrocartilage

We describe an arthroscopic rein-type capsular suture that approximates the triangular fibrocartilage complex to the anatomical footprint, and report the results at a minimum 12 month follow-up. The procedure involves two 3-0 polydioxanone horizontal mattress sutures inserted 1.5 cm proximal to the 6-R and 6-U portals to obtain purchase on the dorsal and anterior radioulnar ligaments, respectively. The two sutures work as a rein to approximate the triangular fibrocartilage complex to the fovea. Ninety patients with Type IB triangular fibrocartilage complex injuries were included retrospectively. The 12-month postoperative Modified Mayo Wrist scores, Disabilities of Arm, Shoulder and Hand scores and visual analogue scale for pain showed significant improvements on preoperative values. Postoperative range of wrist motion, grip strength and ultrasound assessment of the distal radioulnar joint stability were comparable with the normal wrist. The patients had high satisfaction scores for surgery. There were minor complications of knot irritation. No revision surgery for distal radioulnar joint instability was required. It is an effective and technically simple procedure that provides a foveal footprint contact for the triangular fibrocartilage complex. Level of evidence: IV

The Volar Distal Radioulnar Portal in Wrist Arthroscopy: An Anatomical Study

2020 ◽  
Author(s):  
Francisco J. Lucas ◽  
Vicente Carratalá ◽  
Ignacio Miranda ◽  
Cristobal Martinez-Andrade
Keyword(s):  
At Risk ◽  
Ulnar Nerve ◽  
Surgical Techniques ◽  
Anatomical Study ◽  
Neurovascular Bundle ◽  
Wrist Arthroscopy ◽  
Iatrogenic Injuries ◽  
Flexor Carpi Ulnaris ◽  
Human Cadavers ◽  
Triangular Fibrocartilage

Abstract Background Advances in wrist arthroscopy and the emergence of novel surgical techniques have created a need for new portals to the wrist. The aim of this study was to define and verify the safety of the volar distal radioulnar (VDRU) portal. Description of the Technique The VDRU portal is located ∼5 to 10 mm proximal to the proximal wrist crease, just on the ulnar edge of flexor carpi ulnaris tendon and radial to the dorsal cutaneous branch of the ulnar nerve. The ulnar styloid marks the distal point of the portal. Methods An anatomical study was performed on 12 upper extremity specimens of 6 human cadavers. Iatrogenic injuries of neurovascular structures potentially at risk were assessed, and the distance from the portal to these structures was measured. Results No iatrogenic injuries of the structures at risk occurred. Mean distances from the VDRU portal to the ulnar neurovascular bundle, the radial branch of the dorsal sensory branches of the ulnar nerve (DSBUN), and the ulnar branch of the DSBUN were 9.29 ± 0.26 mm, 8.08 ± 0.25 mm, and 10.58 ± 0.23 mm, respectively. There were no differences between left and right wrists. The distances from the VDRU portal to the ulnar neurovascular bundle and the ulnar branch of the DSBUN were significantly shorter in women; this distance was not less than 7 mm in any case. Conclusions The VDRU portal is safe, reproducible, and facilitates the implementation of various techniques related to triangular fibrocartilage complex pathology.

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