Outcomes After Wrist Arthroscopy for the Treatment of Scapholunate Predynamic Instability in the Young Active Patient

Abstract

Purpose: Predynamic instability in scapholunate (SL) ligament tears is a source of wrist pain. Despite this, identifying the proper treatment remains elusive. The purpose of this study was to evaluate return to activity after wrist arthroscopic electrothermal shrinkage for treatment of SL predynamic instability. Methods: Patients enrolled in an ongoing quality assurance project of wrist arthroscopic electrothermal shrinkage surgery for treatment of SL predynamic instability in an active duty military patient cohort were included in this retrospective review. Primary outcomes at a 2-year minimum follow-up were the rate of return to full duty and the rate of return to push-up activities. Results: This study identified 14 active duty patients who met inclusion criteria, mean age 29 years. Six were male and 9 of 14 had concomitant arthroscopic occult dorsal ganglion cyst removal at the time of the index surgery. The severity of SL instability was staged using the Geissler classification; the cohort distribution for stages I, II, and III was 3 patients, 10 patients, and 1 patient, respectively. At 2-year followup, the return to duty rate was 12 out of 14 and the return to push-ups activity rate was 11 out of 14. Pain with activities by visual analog scale was reduced from 7.1 to 1.4. Conclusions: Prior studies demonstrated SL ligament electrothermal shrinkage as a useful modality for pain relief. Our study suggests that this treatment may also aid in return to duty and push-up activities for young active patients. Type of study/level of evidence: Therapeutic IV.

Surgical Outcomes Regarding Wrist Ganglion Cysts Based on Surgical Experience

“…Physicians should carefully examine the scapholunate ligament in small and occult ganglion cysts that are not clinically palpable but cause dorsal wrist pain (10). The size of the incision should give surgeons sufficient visibility and examination opportunities, and surgeons should avoid tiny incisions.…”

Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options

“…1 ). 1 37 38 39 40 41 42 43 44 45 46 47 48 49 Substantial inter-reviewer agreement was obtained for both the title and abstract screening (κ = 0.899; 95% confidence interval [CI]: 0.874–0.923) and for full-text screening (κ = 0.777; 95% CI: 0.604–0.950). There was one level III evidence case–control study 48 and 13 level IV evidence case series studies ( Table 1 ).…”

“…The pre- and postintervention VAS pain scores were reported in four studies in the ES group (one study only reported postintervention), 37 38 39 40 three studies in the AC group (one study only reported postintervention), 42 43 44 three studies in the OC group, 45 47 49 and one study in the NT group. 1 For the ES group the postintervention VAS averaged 1.4 ± 0.5 (preintervention 5.7 ± 1.8), for the AC group the VAS averaged 3.2 ± 1.3 (preintervention 6.6 ± 0), for the OC group the VAS averaged 2.3 ± 2.1 (preintervention 5.6 ± 1.6), and for the NT group the average was 3.2 (preintervention 7.6) ( Table 3 ).…”

“…There were five studies included in the ES group [37][38][39][40][41] consisting of 69 patients with an average age of 34.3 AE 3.3 years, the percentage of patients that was female averaged 57.9% AE 18.5, and the average follow-up period was 43.7 AE 20.1 months. There was a total of 11 wrists graded Geissler I, 52 wrists graded Geissler II, and 6 wrists graded Geissler III (►Table 2).…”

“…The pre-and postintervention VAS pain scores were reported in four studies in the ES group (one study only reported postintervention), [37][38][39][40] three studies in the AC group (one study only reported postintervention), [42][43][44] three studies in the OC group, 45,47,49 and one study in the NT group. The preintervention and postintervention PRWE scores were reported in one study in the ES group (only reported postintervention), 38 one study in the AC group (only reported postintervention), 43 and four studies in the OC group.…”