Review article

Advances in arthroscopic surgery of the wrist: from resection to reconstruction

Pak-Cheong Ho ; Division of Hand & Microsurgery, Department of Orthopaedic & Traumatology, Prince of Wales Hospital Chinese University of Hong Kong, Hong Kong, SAR
Wing-Lim Tse ; Division of Hand & Microsurgery, Department of Orthopaedic & Traumatology, Prince of Wales Hospital Chinese University of Hong Kong, Hong Kong, SAR
Clara Wing-Yee Wong ; Division of Hand & Microsurgery, Department of Orthopaedic & Traumatology, Prince of Wales Hospital Chinese University of Hong Kong, Hong Kong, SAR
Leung-Kim Hung ; Division of Hand & Microsurgery, Department of Orthopaedic & Traumatology, Prince of Wales Hospital Chinese University of Hong Kong, Hong Kong, SAR

Abstract

One of the major advances in wrist arthroscopy is the development of various therapeutic procedures since the 90’s. Therapeutic procedures are no longer restricted to resection. More specific repair procedures and functional reconstruction involving replenishment of tissue defect and augmentation of vital structures are seen with proven value. In particular, wrist arthroscopy performed under local anaesthetic setting without tourniquet and sedation markedly reduces the risk and cost. This article highlights the common indications and applications of wrist arthroscopy, with emphasis on the latest and significant innovations in reconstructive arthroscopic surgery in Hong Kong. On the resection aspect, common procedures include joint debridement, synovectomy, ganglionectomy, capsular release and osteotomies. Reparative surgery includes ligament repair, arthroscopic assisted reduction and fixation of fracture dislocation and chondroplasty for small chondral lesions. Reconstructive surgery embraces surgical solutions tackling on osseous, soft tissue and cartilage problems. Scaphoid nonunion can be treated by arthroscopic bone grafting and percutaneous fixation with union rate of over 90 %. Partial wrist fusion can be achieved arthroscopically to maximize motion and to enhance union by preserving soft tissue and vascularity. Arthroscopic assisted reconstruction of the radio-ulnar ligaments with tendon graft can be performed to treat chronic distal radioulnar joint instability through bone tunnels in sigmoid notch and ulnar fovea. In chronic scapholunate (SL) instability, the dorsal and palmar portion of the SL interosseous ligament is reconstituted anatomically through arthroscopically assisted reconstruction with tendon graft in a box-like structure. In cartilage reconstruction, post–traumatic chondral lesion can be treated with arthroscopic osteochondral transplant.

Keywords

anaesthesia; arthroscopy; indication; reconstruction; technique; wrist

Hrčak ID:

135686

URI

https://hrcak.srce.hr/135686

Publication date:

2.3.2015.

Article data in other languages: croatian

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