Arthroscopically Assisted Sauvé-Kapandji Procedure

Abstract

Osteoarthritis of distal radioulnar joint (DRUJ) leads to chronic wrist pain, weakness of grip strength, and limitation of motion, all of which affect the quality of life of the patient. Over the years, several procedures have been used for the treatment of this condition; however, this condition still remains a therapeutic challenge for the hand surgeons. Many procedures such as Darrach procedure, Bower procedure, Sauvé-Kapandji procedure, and ulnar head replacement have been used. Despite many advances in wrist arthroscopy, arthroscopy has not been used for the treatment of arthritis of the DRUJ. We describe a novel technique of arthroscopically assisted Sauvé-Kapandji procedure for the arthritis of the DRUJ. The advantages of this technique are its less invasive nature, preservation of the extensor retinaculum, more anatomical position of the DRUJ, faster rehabilitation, and a better cosmesis.

Results of the Sauvé-Kapandji Procedure for Posttraumatic Disorders of the Distal Radioulnar Joint in Young Patients

“…For the author, the arthrodesis of the distal radioulnar joint can be performed safely and successfully, without being obliged to open the fifth and sixth extensor compartments. In addition, assisted arthroscopic arthrodesis of the distal radioulnar joint offers the advantage of faster rehabilitation and a better cosmesis [9]. However, this is a demanding technique and should only be used by surgeons having a good experience in wrist arthroscopy.…”

“…In our context, we were not brought to perform the radial osteotomy because the angulation of the radio carpal joint was minimal and significantly lower in the range determined by Tsukazaki. In an article of luchetti [9], the Sauvé-Kapandji procedure can be carried out under arthroscopic control. For the author, the arthrodesis of the distal radioulnar joint can be performed safely and successfully, without being obliged to open the fifth and sixth extensor compartments.…”

Resultados de la técnica de sauvé-kapandji asistida por artroscopia con estabilización ulnar proximal

“…Se realiza una técnica de S-K artroscópica como la descrita por Luchetti 2 a la que se añade una estabilización tendinosa del muñón proximal mediante la técnica descrita por Minami. 13…”

“…En posición de pronosupinación neutra, el contacto entre las carillas es del 60%, el cual pasa a ser sólo de 2 o 3 mm en pronación o supinación máxima, lo que supone un menor grado de estabilidad. 2 Además, durante la pronosupinación del antebrazo se produce una combinación de movimientos de rotación y traslación que permiten el desplazamiento de la cabeza ulnar sobre la escotadura sigmoidea. Todo esto produce que la ARCD sea inestable desde el punto de vista óseo y biomecánico.…”

“…La técnica de S-K artroscópica, descrita por Luchetti 2 permite un procedimiento menos invasivo y con mejor resultado estético, preservando el retináculo extensor, mejorando la colocación de la ARCD en una posición más anatómica y permitiendo una rehabilitación más precoz. El procedimiento de S-K consiste en la realización de una artrodesis de la ARCD con una osteotomía del cúbito, conservando la relación entre la fosa sigmoidea del radio y la cabeza ulnar, lo que mejora la transmisión de cargas, principalmente para gente joven con altas demandas funcionales.…”