gms | German Medical Science

Objectives/Interrogation: Wrist osteoarthritis can be localised to different articular surfaces of radiocarpal or inter-carpal joints and develops according to predictive patterns. The most frequent causes of the degenerative disease are post-traumatic (SLAC and SNAC wrist) that after many years lead to carpal collapse. Other causes can also related to deposition of calcium pyrophosphate in the joint (SCAC wrist), or advanced stages of osteonecrosis of lunate or carpal bones or previous infections while primary conditions are rare.

The degenerative condition can be studied with plain radiographs and advanced diagnostic imaging techniques as CT scan and MRI scan. Wrist arthroscopy is an additional technique that allows the direct visualization of articular surfaces and identify precisely the damaged intra-carpal joints. Arthroscopy has a higher sensibility and specificity compared to MRI and is considered the gold standard in evaluating cartilage damage. The aim of this study is to use arthroscopy as a guide to surgical choice in order to preserve the intact joints and avoid progression of arthritis.

Methods: Thirty-two patients underwent wrist arthroscopy before the planned surgical procedure. All patients had XRays and CT scan or MRI scan pre-operatively. All were males, mean age 52 (38- 65). There were 16 SNAC, 13 SLAC and 3 Kienbock Disease. Arthroscopy can be performed as a separate-first step procedure or at the same operating time. Radio-carpal joint and midcarpal joints are examined with standard portals (3-4, 6R, MCR, MCU). Additional portals can be added if needed.

Results and Conclusions: The surgical treatment was modified according to arthroscopic finding in all patients. The disadvantage of this procedure is the increase of operating time or necessity of two procedures to be performed. Open surgical treatment was performed after arthroscopy in a one-step procedure in 7 cases and in two steps in 25 patients.

With the use of arthroscopy the treatment can be tailored according to the residual intact cartilage surfaces in order to have more durable results. Sometimes it is possible to post-pone salvage procedures and find more conservative solutions expecially in the early stages of SLAC and SNAC.