Wrist Arthroscopy: Current Concepts

Slutsky, David J.; Nagle, Daniel J.

doi:10.1016/j.jhsa.2008.07.015

Cited by 44 publications

(23 citation statements)

References 52 publications

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“…Wrist arthroscopy has become an accepted and established therapeutic procedure in recent decades [1][2][3]. Besides diagnostic exploration, several techniques to restore integrity of the joint have been described [4,5].…”

Section: Introductionmentioning

confidence: 99%

Wrist arthroscopy in children and adolescents: a single surgeon experience of thirty-four cases

Farr

Grill

Girsch

2011

International Orthopaedics (SICOT)

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Section: Introductionmentioning

confidence: 99%

Wrist arthroscopy in children and adolescents: a single surgeon experience of thirty-four cases

Farr

Grill

Girsch

2011

International Orthopaedics (SICOT)

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“…It may result from osteochondral fractures, chronic carpal instability, or chondromatosis, or it may occur idiopathically. 14 Cheng, in reviewing the surgical treatment on 22 patients with chronic pain post distal radius fracture treatment, noted chondral lesions in 63.6% of them. Fifty percent of them involved the radiocarpal joint and occurred at the distal radius.…”

Section: Discussionmentioning

confidence: 99%

“…The combined extension/flexion range of the wrist was 140°(►Fig. 14). The surgical scar was inconspicuous (►Fig.…”

Section: Case Illustrationmentioning

confidence: 99%

Arthroscopic Osteochondral Grafting for Radiocarpal Joint Defects

Tse

Wong

et al. 2013

Jnl Wrist Surg

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Background?Focal chondral lesion is a common cause of chronic wrist pain. The best treatment remains unknown. We have developed a technique of arthroscopic transplantation of an osteochondral autograft from the knee joint to the distal radius with satisfactory clinical results. Materials and Methods?Between December 2006 and December 2010, four patients (average age 31 years) with posttraumatic osteochondral lesions over the dorsal lunate fossa were treated with arthroscopic osteochondral grafting. Pre- and postoperative motion, grip strength, wrist functional performance score, pain score, and return to work status were charted. Postoperative computed tomography (CT) scan, magnetic resonance imaging (MRI), and second-look arthroscopy were performed to assess graft incorporation. Description of Technique?With the arthroscope in the 3?4 portal, synovitis over the dorsal lunate fossa was d?brided to uncover the underlying osteochondral lesion. We employed the 6-mm trephine of the Osteoarticular Transfer System (OATS) to remove the osteochondral defect. Osteochondral graft was harvested from the lateral femoral condyle and delivered into the wrist joint arthroscopically. Results?In all cases, grafts incorporation was completed by 3?4 months postoperative. All patients showed improvement in the wrist performance score (preoperative 27.5, postoperative 39 out of 40) with no pain on final follow-up at average 48.5 months (range 24?68 months). Grip strength improved from 62.6 to 98.2% of the contralateral side. Motion improved from 115.5 to 131.3?. X-ray images showed preserved joint space. Patient satisfaction was high with no complication. Conclusion?An arthroscopic-assisted transfer of an osteochondral graft is a viable treatment option for chondral defects of the distal radius.

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“…For the arthroscopy, standard dorsal portals (3/4; 4/5) were used for arthroscopy of the radio and ulnocarpal joints, as well as of the midcarpal joint (ulnar/radial). 10 No volar or DRUJ portals were used in this series.…”

Section: Surgical Techniquementioning

confidence: 99%

Wide-Awake Wrist Arthroscopy and Open TFCC Repair

Hagert

Lalonde

2012

Jnl Wrist Surg

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The wide-awake approach to hand surgery involves the subcutaneous and intra-articular injection of large volumes of diluted lidocaine and epinephrine in the forearm, wrist, hand, and fingers. Benefits include the deletion of the risks and inconveniences of general anesthesia and the ability to watch the patient take reconstructed hand tissues through an active range of motion for adjustment of the reconstruction before the skin is closed. 1Watching comfortable patient's active movement during the surgery has shown major benefit in allowing reduced rupture rates in flexor tendon repair, 2-5 as well as improved tension setting in tendon transfers. 6 Wide-awake surgery has Keywords ► arthroscopy ► local anesthesia ► proprioception ► TFCC ► wide-awake surgery ► wrist AbstractThe wide-awake approach to hand surgery entails the use of local infiltration anesthesia using lidocaine with epinephrine and no tourniquet. The technique provides practitioners with an option to perform advanced hand surgical care in an ambulatory setting, without the need for general or regional anesthetics. We present our results using wideawake approach in wrist surgery, both open and arthroscopic. Between June and August 2011, the wide-awake approach was used in nine elective wrist surgery cases; three arthroscopic procedures, four open triangular fibrocartilage complex (TFCC) repairs, and two combined arthroscopy/open surgery (eight men/one woman). The arthroscopic patients were anesthetized using dorsal infiltration of lidocaine with epinephrine (20 mL) with an additional intra-articular 5 mL injection 30 minutes before surgery. The open surgery patients received 40 mL of lidocaine with epinephrine around the ulnar aspect of the forearm, from 8-cm proximal to 3-cm distal to the distal radioulnar joint. Standard diagnostic radio-and midcarpal arthroscopies were performed, where one patient had a loose body removed and two patients underwent TFCC debridements due to central TFCC tears. The six open cases were all due to TFCC foveal disruptions, which were reinserted using osteosutures in the distal ulna. Following placement of the ligament sutures, a preliminary knot allowed active and passive motion testing of pronosupination, to determine the adequate amount of tension in the ligaments. The wide-awake approach to wrist surgery is a plausible and reliable technique that eliminates the need for general anesthesia, removes the need of a tourniquet, and provides a cost-efficient and safe approach to wrist surgery. The ability to control ligament reconstructions using active motion may additionally enhance the rehabilitation of these patients, both through early proprioceptive awareness and adequate tensioning of soft tissues.

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Wrist Arthroscopy: Current Concepts

Cited by 44 publications

References 52 publications

Wrist arthroscopy in children and adolescents: a single surgeon experience of thirty-four cases

Wrist arthroscopy in children and adolescents: a single surgeon experience of thirty-four cases

Arthroscopic Osteochondral Grafting for Radiocarpal Joint Defects

Wide-Awake Wrist Arthroscopy and Open TFCC Repair

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