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In the last two decades, surgeons have rapidly developed arthroscopic techniques to treat basal joint osteoarthritis. Such techniques spare the joint capsule and ligaments, allow more accurate staging of cartilage degeneration to determine the most appropriate treatment, and decrease the risk of injury to the radial artery and superficial branch of the radial nerve. Arthroscopic resection arthroplasty of the trapezium can be performed as either partial or complete trapeziectomy. Many papers have described partial trapeziectomy but few have discussed complete trapeziectomy.Suture button implants avoid the drawbacks of temporary fixation using Kirschner wire, as well as the drawbacks of ligament reconstruction, which necessitates the sacrifice of a tendon and involves both wide exposure and scar tissue.This paper aimed to review the published data on the arthroscopic treatment of basal thumb osteoarthritis, with a special focus on stabilization using suture button suspensionplasty, and to present a technique that structures this procedure into three steps, allowing it to be performed in an easier, more organized, and faster way.

Background?Nowadays, the wrist is not limited to a dorsal visualization; the joint can be thought of as a ?box,? which can be visualized from almost every perspective. The purpose of this study was to describe a new volar central portal for the wrist, following three principles: a single incision that allows access to both the radiocarpal and midcarpal joints, centered on the lunate, with the volar structures at risk protected not only by retractors, but also by tendons. Description of Technique?The incision begins in the distal wrist crease and extended 1.5 cm proximally up to the proximal wrist crease, following the axis of the third intermetacarpal space. The flexor superficialis tendons are identified and retracted toward the radial side. Next, the fourth and fifth flexor digitorum profundus tendons are retracted toward the ulnar side, while the third and second tendons are retracted toward the radial side. The volar central midcarpal portal is performed under direct vision just over the anterior horn of the lunate through the Poirier space. The volar central radiocarpal portal is created under the lunate through the interval between the ulnocarpal ligaments and the short radioulnar ligament. Methods?An anatomical study was performed on 14 cadaver specimens. Two data were recorded: iatrogenic injuries of the structures at risk and the distances to the structures at risk. Results?The median (interquartile range [IQR]) distances from the volar central radiocarpal portal to the median nerve, palmar cutaneous branch of the median nerve, and ulnar neurovascular bundle were 10.5 (7.8?15.0), 18.5 (15.8?20.3), and 7.0 (5.0?10.5) mm, respectively. The median (IQR) distances from the volar central midcarpal portal to the median nerve, palmar cutaneous branch of the median nerve, and ulnar neurovascular bundle were 7.0 (4.8?10.3), 16.0 (14.8?19.0), and 4.5 (3.8?9.0) mm, respectively. No iatrogenic injuries were observed. Conclusion?The volar central portal is reproducible and safe. The risk of iatrogenic injury is low. The capsule is pierced through one of its thinner portions, and both the radiocarpal and midcarpal joints can be inspected through one single incision.

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It is difficult for an inexperienced surgeon to achieve a correct component alignment in his/her first total wrist arthroplasty, especially in the carpal component. Therefore, we recommend that the position of the prosthesis is confirmed before securing it to the bone with the help of X-ray images.

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Patients with scapholunate instability usually have pain in the dorsal wrist. This pain may occur due to the impingement between the scaphoid and the dorsal rim of the radius when the scaphoid is detached from the lunate. This pain appears as the scaphoid is displaced over the dorsal rim of the radius. The arthroscopic scaphoid 3D (dorsal, dynamic, displacement) test is described here to check this pathologic dorsal displacement of the scaphoid. The test should be performed both in the radiocarpal and midcarpal joints. Traction is released and the arthroscope is set under the lunate when tested in the radiocarpal joint and on the lunate when tested in the midcarpal joint. The scaphoid is manually pushed dorsally at the scaphoid tubercle. If there was no scapholunate instability, all the proximal row bones are minimally displaced: a negative test. If there was scapholunate instability, the scaphoid is displaced dorsally while the lunate remains static: evaluated as positive. This test can add information to the arthroscopic classifications of the scapholunate instability, which explore both the proximal to distal displacement of the scaphoid (the step-off) and the ulnar to radial displacement (the gap), as this test explores the volar to dorsal displacement.