Arthroscopic Distal Scaphoid Resection for Scapho-Trapezium-Trapezoid Arthritis

Abstract

Background: The purpose of this study was to describe the technique of arthroscopic resection of the scaphoid head and evaluate both the clinical and radiographic results of scapho-trapezium-trapezoid osteoarthritis cases. Methods: Seventeen cases (13 men and 4 women) with a mean age of 57 years (24-74 years) were operated on from 2002 to 2015. Inclusion criteria were nontraumatic radial-sided wrist pain without improvement after 4 months of conservative treatment and positive radiographic images demonstrating the presence of osteoarthritis. All cases were evaluated preoperatively and postoperatively using visual analog scale, wrist range of motion (ROM), grip strength, and patient’s work status (Mayo Wrist Score). Disabilities of the Arm, Shoulder, and Hand (DASH) and Patient-Rated Wrist/Hand Evaluation (PRWHE) questionnaires were also administered. The technique consisted of performing a 3- to 4-mm round-shaped scaphoid head resection via arthroscopy while preserving the scaphotrapezial and scaphocapitate ligament insertions. Results: At an average follow-up of 24 months, all the patients were satisfied. The results showed statistically significant improvement in pain at rest ( P = .001), under maximal load ( P = .0001), and in Mayo Wrist Score (MWS) ( P = .0001). Wrist ROM, grip strength, DASH, and PRWHE showed an improvement without reaching statistical significance. The mean preoperative radiolunate (RL) X-ray measurement angle was 17° (–10° to 35°). The postoperative mean value was 25° (0°-45°). In the preoperative radiographic evaluation, 11 cases exceeded the “critical” 15° RL angle. At follow-up, the RL angle increased in 10 cases and remained unchanged in 7 cases. None of these cases became symptomatic. Transitory neurapraxia of the dorsal superficial branch of the radial nerve was observed in 1 case. Damage of the dorsal branch of the radial artery was immediately fixed. Conclusions: Arthroscopic resection of the distal portion of the scaphoid due to scapho-trapezium-trapezoid osteoarthritis demonstrated an effective and safe technique with less complications than open surgery.

Procedimentos assistidos por artroscopia no punho e na mão: Atualização. Onde nós estamos?

“…Iida et al 23 studied the impact of arthroscopic resection of the distal pole of the scaphoid and found good results, as long as the resection did not exceed 3 mm and there was no associated carpal instability (DISI). Luchetti et al 24 found similar results, adding that the technique does not contraindicate cases of associated trapeziometacarpal arthrosis, as long as it is treated concomitantly. Mathoulin and Darin 25 had already published their series using this same technique, with the exception that, in the long term, an impingement phenomenon could occur at the joint level, justifying the addition of pyrocarbon implants to maintain physiological carpal height.…”

“…Iida et al 23 estudaram o impacto da ressecção artroscópica do polo distal do escafoide e encontrou bons resultados, desde que a ressecção não excedesse os 3mm e que não houvesse instabilidade carpal associada (DISI). Luchetti et al 24 encontraram resultados semelhantes, acrescentando que não contraindica a técnica para casos de artrose trapeziometacarpal associada, desde que tratada concomitantemente. Mathoulin e Darin 25 já haviam publicado sua série com essa mesma técnica, com a ressalva que, a longo prazo, poderia ocorrer um fenômeno de impingement a nível da articulação, justificando o acréscimo de implantes de pirocarbono para manter a altura carpal fisiológica.…”

Introducing the “SOAC Wrist”: Scaphotrapeziotrapezoid Osteoarthritis Advanced Collapse

“…It requires less immobilization time and has fewer complications than arthrodesis, but can create midcarpal instability and DISI deformity, or even worsen such problems if already existent. 30,[45][46][47] Most authors nowadays recommend the association of some type of carpal stabilization to the distal scaphoid resection. 10,[42][43][44] Some authors propose the use of metal interposition arthroplasties for such a purpose.…”

Osteoarthritis of the wrist

“…Bei einer isolierten STT-Arthrose hebt eine arthroskopische Resektionsarthroplastik den Knochenkontakt zwischen Os trapezium, Os trapezoideum und Os scaphoideum auf. Arthroskopische Resektionen erfordern arthroskopische Erfahrung ([ 36 ]; Abb. 6 ).…”