gms | German Medical Science

Objectives/Interrogation: To report on the prevalence of associated chondromalacia and other pathologies in patients with Dynamic Scaphoid Instability Garcia Elias (GE) stage III and to report on the efficacy of arthroscopic treatment for stage III with and without chondromalacia.

Methods: From 191 consecutive wrist arthroscopies, 150 were diagnosed with dynamic scaphoid instability. 79 (53%) were classified as GE stage III. 71 (47%) were classified as GE stage III with additional chondromalacia and other associated intercarpal pathologies. Average age at time of arthroscopy was 42 years old and average follow-up was 5.1 years. (range 1-10 years).

Results and Conclusions: 58% of wrists with true GE stage III were treated by arthroscopy debridement alone and did not require further treatment. Average follow-up was 4.7 years. 42% required dynamic stabilization of the scaphoid (Dynadesis).

47% of wrists were classified as GE stage III with chondromalacia of the ulnar column and other disorders (52% radial styloid impingement, 23% hamate chondromalacia, 16% Triquetrum chondromalacia, 50% TFCC tear, 11% ulna head chondromalacia) and were treated by arthroscopy debridement and abrasion arthroplasty, partial carpectomy, TFCC excision, and radial styloidectomy. 62% did not require further treatment and 73% of this group reported no wrist pain. The average follow-up was 5.7 yrs. 38% of GE stage III with chondromalacia required additional surgery (Dynadesis and/or indicated stabilization procedures).

Dynamic scaphoid instability of GE stage III can include chondromalacia and other associated wrist pathology. We suggest this group be called stage GE3+.

Arthroscopy treatment alone was successful in more than 50% of the GE 3 and GE 3+ patients with an average of 5 years follow-up. We anticipate that with a longer follow-up some of these patients will eventually require further surgery.