Biomechanical comparison of arthroscopic and open lunate excisions in the cadaveric wrist

Onishi, Tadanobu; Kira, Tsutomu; Omokawa, Shohei; Iida, Akio; Shimizu, Takamasa; Kawamura, Kenji; Nagashima, Mitsuyuki; Mahakkanukrauh, Pasuk; Tanaka, Yasuhito

doi:10.1016/j.clinbiomech.2021.105343

Cited by 2 publications

(1 citation statement)

References 27 publications

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“…The same group also performed a comparison of arthroscopic and open lunate excisions in a cadaveric model, and found no significant difference in the rotation angle of the scaphoid between the two, although a significant increase in the STD, triquetral dorsiflexion, and triquetral supination was noted. 21 This study was limited, however, by small numbers and a failure to accurately recreate the conditions of an open lunate excision. In particular, the extensor retinaculum and dorsal wrist capsule (which are routinely repaired and scar down during the postoperative period of immobilization, likely providing a secondary restraint to carpal instability) were sectioned and left unreconstructed during the open procedure, along with the intrinsic and dorsal extrinsic carpal ligaments.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease

Merlini,

Maffeis,

Mathoulin

et al. 2023

J Wrist Surg

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Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.

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Section: Discussionmentioning

confidence: 99%