Arthroscopic Partial Resection for Type 1a Avascular Necrosis of the Capitate

Purpose: The goal of the study is to examine short-term clinical results of arthroscopic partial resection for type 1a avascular necrosis of the capitate.

Methods: Patients who underwent arthroscopic treatment for type 1a avascular necrosis of the capitate with at least 1-year follow-up were identified through a retrospective chart review. The necrotic capitate head was arthroscopically resected, with removal of the lunate facet and preservation of the scaphoid and hamate facet (Fig. 1). Range of wrist motion, grip strength, and radiographic parameters—carpal height ratio (CHR), radioscaphoid angle (RSA), and radiolunate angle (RLA)—were determined preoperatively and at the latest follow-up. Patients completed a visual analog score (VAS) for pain; the Disabilities of the Arm, Shoulder, and Hand (DASH) scale; and the Patient-Rated Wrist Evaluation (PRWE) before surgery and at the latest follow-up.

Results: Five patients (one male, four females; mean age 34 years, range 16–49 years) with a mean follow-up of 19.6 months (12–36 months) were identified in the chart review. All cases were type 1a in the Milliez classification. Arthroscopy revealed fibrillation or softening with cartilage detachment at the lunate facet of the capitate head and an intact articular surface at the scaphoid facet. At the latest follow-up, the mean wrist flexion-extension was 124° (versus 81° preoperatively) and grip strength was 74% (versus 37%). VAS, DASH, and PRWE scores showed significant improvement. Radiographically, changes in CHR, RSA, and RLA did not reach significance at final follow-up; however, the proximal carpal row showed a tendency toward flexion. Postoperative MRI showed satisfactory revascularization in the remaining capitate (Fig. 2).

Conclusions: Arthroscopic partial resection of the capitate head is an acceptable surgical procedure for type 1a avascular necrosis of the capitate. This procedure provides adequate pain relief and maintains the range of wrist motion and grip strength over a short follow-up period.

Fig. 1

Fig. 2