Arthroscopic Resection Arthroplasty of the Radial Column for SLAC Wrist

Abstract

Background Symptomatic advanced scapholunate advanced collapse (SLAC) wrists are typically treated with extensive open procedures, including but not limited to scaphoidectomy plus four-corner fusion (4CF) and proximal row carpectomy (PRC). Although a minimally invasive arthroscopic option would be desirable, no convincing reports exist in the literature. The purpose of this paper is to describe a new surgical technique and outcomes on 14 patients who underwent arthroscopic resection arthroplasty of the radial column (ARARC) for arthroscopic stage II through stage IIIB SLAC wrists and to describe an arthroscopic staging classification of the radiocarpal joint for patients with SLAC wrist. Patients and Methods Data were collected prospectively on 17 patients presenting with radiographic stage I through III SLAC wrist who underwent ARARC in lieu of scaphoidectomy and 4CF or PRC. Fourteen patients (12 men and 2 women) subject to 1-year follow-up were included. The average age was 57 years (range 41 to 78). The mean follow-up was 24 months (range 12 to 61). Arthroscopic resection arthroplasty of the radial column is described for varying stages of arthritic changes of the radioscaphoid joint. Midcarpal resection was not performed. Results The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 66 preoperatively and 28 at final follow-up. The mean satisfaction (0 ¼ not satisfied, 5 ¼ completely satisfied) at final follow-up was 4.5 (range 3 to 5).

Arthroscopic Resection Arthroplasty for Scapholunate Advanced Collapse (SLAC Wrist)

“…Arthroscopic treatment can be performed for all three stages. Arthroscopic resection arthroplasty (ARA) is performed by removing the radial styloid and the arthritic portion of the scaphoid fossa and approximately 2/3 of the proximal scaphoid [2]. Midcarpal resection in stage 3 patients is not necessary in our experience for pain relief.…”