Download PDF
J Wrist Surg 2014; 03(02): 114-122
DOI: 10.1055/s-0034-1373839
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Resection Arthroplasty of the Radial Column for SLAC Wrist

Tyson K. Cobb
1   Orthopaedic Specialists, Inc., Davenport, Iowa
,
Anna L. Walden
1   Orthopaedic Specialists, Inc., Davenport, Iowa
,
Jessica M. Wilt
1   Orthopaedic Specialists, Inc., Davenport, Iowa
› Author Affiliations
Further Information

Publication History

Publication Date:
17 May 2014 (online)

    Permissions and Reprints

Abstract

Background Symptomatic advanced scapholunate advanced collapse (SLAC) wrists are typically treated with extensive open procedures, including but not limited to scaphoidectomy plus four-corner fusion (4CF) and proximal row carpectomy (PRC). Although a minimally invasive arthroscopic option would be desirable, no convincing reports exist in the literature. The purpose of this paper is to describe a new surgical technique and outcomes on 14 patients who underwent arthroscopic resection arthroplasty of the radial column (ARARC) for arthroscopic stage II through stage IIIB SLAC wrists and to describe an arthroscopic staging classification of the radiocarpal joint for patients with SLAC wrist.

Patients and Methods Data were collected prospectively on 17 patients presenting with radiographic stage I through III SLAC wrist who underwent ARARC in lieu of scaphoidectomy and 4CF or PRC. Fourteen patients (12 men and 2 women) subject to 1-year follow-up were included. The average age was 57 years (range 41 to 78). The mean follow-up was 24 months (range 12 to 61). Arthroscopic resection arthroplasty of the radial column is described for varying stages of arthritic changes of the radioscaphoid joint. Midcarpal resection was not performed.

Results The mean Disabilities of the Arm, Shoulder, and Hand (DASH) score was 66 preoperatively and 28 at final follow-up. The mean satisfaction (0 = not satisfied, 5 = completely satisfied) at final follow-up was 4.5 (range 3 to 5). The pain level (on 0–10 scale) improved from 6.6 to 1.3. The total arc of motion changed from 124° preoperatively to 142° postoperatively following an ARARC. Grip was 16 kg preoperatively and 18 kg postoperatively. Radiographic stages typically underestimated arthroscopic staging. Although four of our patients appeared to be radiographic stage I, all were found to have arthritis involving some or all of the radioscaphoid articulation at the time of arthroscopy.

Clinical Relevance Pain relief is rapid and remains consistent over time following ARARC. ARARC may be a viable surgical option for patients with SLAC wrist who desire a minimally invasive procedure. Radiographic stages underestimate the degree of arthritic change. Accurate staging requires arthroscopy. The indications and long-term outcome are not well defined; continued surveillance is warranted.

Level of Evidence Level IV, Therapeutic study

Keywords

arthritis - arthroplasty - arthroscopic - arthroscopy - minimally invasive - resection - scapholunate advanced collapse - SLAC - wrist

Ethical Review Committee Statement

Necessary and appropriate consent was obtained from each patient, and the study protocol conformed to the ethical guidelines of the 1975 Declaration of Helsinki as reflected by prior approval by the Genesis Health Systems institutional review committee.


 

  • References

  • 1 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (3) 358-365
    CrossrefPubMedGoogle Scholar
  • 2 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (1) 125-134
    CrossrefPubMedGoogle Scholar
  • 3 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
    CrossrefPubMedGoogle Scholar
  • 4 Fassler PR, Stern PJ, Kiefhaber TR. Asymptomatic SLAC wrist: does it exist?. J Hand Surg Am 1993; 18 (4) 682-686
    CrossrefPubMedGoogle Scholar
  • 5 Bain GI, Watts AC. The outcome of scaphoid excision and four-corner arthrodesis for advanced carpal collapse at a minimum of ten years. J Hand Surg Am 2010; 35 (5) 719-725
    CrossrefPubMedGoogle Scholar
  • 6 Merrell GA, McDermott EM, Weiss AP. Four-corner arthrodesis using a circular plate and distal radius bone grafting: a consecutive case series. J Hand Surg Am 2008; 33 (5) 635-642
    CrossrefPubMedGoogle Scholar
  • 7 DiDonna ML, Kiefhaber TR, Stern PJ. Proximal row carpectomy: study with a minimum of ten years of follow-up. J Bone Joint Surg Am 2004; 86-A (11) 2359-2365
    PubMedGoogle Scholar
  • 8 Barnard L, Stubbins SG. Styloidectomy of the radius in the surgical treatment of nonunion of the carpal navicular; a preliminary report. J Bone Joint Surg Am 1948; 30A (1) 98-102
    CrossrefPubMedGoogle Scholar
  • 9 Siegel DB, Gelberman RH. Radial styloidectomy: an anatomical study with special reference to radiocarpal intracapsular ligamentous morphology. J Hand Surg Am 1991; 16 (1) 40-44
    CrossrefPubMedGoogle Scholar
  • 10 Nakamura T, Cooney III WP, Lui WH , et al. Radial styloidectomy: a biomechanical study on stability of the wrist joint. J Hand Surg Am 2001; 26 (1) 85-93
    CrossrefPubMedGoogle Scholar
  • 11 Yao J, Osterman AL. Arthroscopic techniques for wrist arthritis (radial styloidectomy and proximal pole hamate excisions). Hand Clin 2005; 21 (4) 519-526
    CrossrefPubMedGoogle Scholar
  • 12 Slutsky DJ, Nagle DJ. Wrist arthroscopy: current concepts. J Hand Surg Am 2008; 33 (7) 1228-1244
    CrossrefPubMedGoogle Scholar
  • 13 Levadoux M, Cognet JM. [Arthroscopic styloidectomy]. Chir Main 2006; 25 (Suppl. 01) S197-S201
    CrossrefPubMedGoogle Scholar
  • 14 Geissler WB. [Arthroscopic management of scapholunate instability]. Chir Main 2006; 25 (Suppl. 01) S187-S196
    CrossrefPubMedGoogle Scholar
  • 15 Chloros GD, Wiesler ER, Poehling GG. Current concepts in wrist arthroscopy. Arthroscopy 2008; 24 (3) 343-354
    CrossrefPubMedGoogle Scholar
  • 16 Bain GI, Munt J, Turner PC. New advances in wrist arthroscopy. Arthroscopy 2008; 24 (3) 355-367
    CrossrefPubMedGoogle Scholar
  • 17 Hudak PL, Amadio PC, Bombardier C ; The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (6) 602-608
    CrossrefPubMedGoogle Scholar
  • 18 Viegas SF, Wagner K, Patterson R, Peterson P. Medial (hamate) facet of the lunate. J Hand Surg Am 1990; 15 (4) 564-571
    CrossrefPubMedGoogle Scholar
  • 19 Nakamura K, Beppu M, Matushita K, Arai T, Ide T. Biomechanical analysis of the stress force on midcarpal joint in Kienböck's disease. Hand Surg 1997; 2: 101-115
    CrossrefPubMedGoogle Scholar
  • 20 Lalonde D. Minimally invasive anesthesia in wide awake hand surgery. Hand Clin 2014; 30 (1) 1-6
    CrossrefPubMedGoogle Scholar
  • 21 Van de Pol GJ, Koudstaal MJ, Schuurman AH, Bleys RL. Innervation of the wrist joint and surgical perspectives of denervation. J Hand Surg Am 2006; 31 (1) 28-34
    CrossrefPubMedGoogle Scholar
  • 22 Wilhelm A. Partial joint denervation: wrist, shoulder, and elbow. Plast Reconstr Surg 2010; 126 (1) 345-347
    PubMedGoogle Scholar
  • 23 Kinjo S, Sands LP, Lim E, Paul S, Leung JM. Prediction of postoperative pain using path analysis in older patients. J Anesth 2012; 26 (1) 1-8
    CrossrefPubMedGoogle Scholar
  • 24 Ruby LK, An KN, Linscheid RL, Cooney III WP, Chao EY. The effect of scapholunate ligament section on scapholunate motion. J Hand Surg Am 1987; 12 (5 Pt 1) 767-771
    CrossrefPubMedGoogle Scholar
  • 25 Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am 1995; 20 (6) 965-970
    CrossrefPubMedGoogle Scholar
  • 26 Hunziker EB. Articular cartilage repair: are the intrinsic biological constraints undermining this process insuperable?. Osteoarthritis Cartilage 1999; 7 (1) 15-28
    CrossrefPubMedGoogle Scholar
  • 27 Hunziker EB, Quinn TM, Häuselmann HJ. Quantitative structural organization of normal adult human articular cartilage. Osteoarthritis Cartilage 2002; 10 (7) 564-572
    CrossrefPubMedGoogle Scholar
  • 28 Aglietti P, Buzzi R, Bassi PB, Fioriti M. Arthroscopic drilling in juvenile osteochondritis dissecans of the medial femoral condyle. Arthroscopy 1994; 10 (3) 286-291
    CrossrefPubMedGoogle Scholar
  • 29 Altman RD, Kates J, Chun LE, Dean DD, Eyre D. Preliminary observations of chondral abrasion in a canine model. Ann Rheum Dis 1992; 51 (9) 1056-1062
    CrossrefPubMedGoogle Scholar
  • 30 Kim HK, Moran ME, Salter RB. The potential for regeneration of articular cartilage in defects created by chondral shaving and subchondral abrasion. An experimental investigation in rabbits. J Bone Joint Surg Am 1991; 73 (9) 1301-1315
    PubMedGoogle Scholar
  • 31 Behrens F, Shepard N, Mitchell N. Metabolic recovery of articular cartilage after intra-articular injections of glucocorticoid. J Bone Joint Surg Am 1976; 58 (8) 1157-1160
    PubMedGoogle Scholar
  • 32 Rae PJ, Noble J. Arthroscopic drilling of osteochondral lesions of the knee. J Bone Joint Surg Br 1989; 71 (3) 534
    PubMedGoogle Scholar
  • 33 Vachon A, Bramlage LR, Gabel AA, Weisbrode S. Evaluation of the repair process of cartilage defects of the equine third carpal bone with and without subchondral bone perforation. Am J Vet Res 1986; 47 (12) 2637-2645
    PubMedGoogle Scholar
  • 34 Salter RB, Simmonds DF, Malcolm BW, Rumble EJ, MacMichael D, Clements ND. The biological effect of continuous passive motion on the healing of full-thickness defects in articular cartilage. An experimental investigation in the rabbit. J Bone Joint Surg Am 1980; 62 (8) 1232-1251
    PubMedGoogle Scholar
  • 35 O'Driscoll SW, Kumar A, Salter RB. The effect of the volume of effusion, joint position and continuous passive motion on intraarticular pressure in the rabbit knee. J Rheumatol 1983; 10 (3) 360-363
    PubMedGoogle Scholar
  • 36 Cobb T, Sterbank P, Lemke J. Arthroscopic resection arthroplasty for treatment of combined carpometacarpal and scaphotrapeziotrapezoid (pantrapezial) arthritis. J Hand Surg Am 2011; 36 (3) 413-419
    CrossrefPubMedGoogle Scholar
  • 37 Culp RW, Rekant MS. The role of arthroscopy in evaluating and treating trapeziometacarpal disease. Hand Clin 2001; 17 (2) 315-319, x–xi
    PubMedGoogle Scholar
  • 38 Edwards SG, Ramsey PN. Prospective outcomes of stage III thumb carpometacarpal arthritis treated with arthroscopic hemitrapeziectomy and thermal capsular modification without interposition. J Hand Surg Am 2010; 35 (4) 566-571
    CrossrefPubMedGoogle Scholar
  • 39 Adams JE, Steinmann SP, Culp RW. Trapezium-sparing options for thumb carpometacarpal joint arthritis. Am J Orthop 2008; 37 (8) (Suppl. 01) 8-11
    PubMedGoogle Scholar
  • 40 Hofmeister EP, Leak RS, Culp RW, Osterman AL. Arthroscopic hemitrapeziectomy for first carpometacarpal arthritis: results at 7-year follow-up. Hand (NY) 2009; 4 (1) 24-28
    CrossrefPubMedGoogle Scholar
  • 41 Leclaire R, Fortin L, Lambert R, Bergeron YM, Rossignol M. Radiofrequency facet joint denervation in the treatment of low back pain: a placebo-controlled clinical trial to assess efficacy. Spine 2001; 26 (13) 1411-1416 , discussion 1417
    CrossrefPubMedGoogle Scholar
  • 42 Dellon AL. Partial joint denervation I: wrist, shoulder, and elbow. Plast Reconstr Surg 2009; 123 (1) 197-207
    CrossrefPubMedGoogle Scholar
  • 43 Wilhelm A. Denervation of the wrist. Tech Hand Up Extrem Surg 2001; 5 (1) 14-30
    CrossrefPubMedGoogle Scholar
  • 44 Weinstein LP, Berger RA. Analgesic benefit, functional outcome, and patient satisfaction after partial wrist denervation. J Hand Surg Am 2002; 27 (5) 833-839
    CrossrefPubMedGoogle Scholar
  • 45 Loréa PD. First carpometacarpal joint denervation: anatomy and surgical technique. Tech Hand Up Extrem Surg 2003; 7 (1) 26-31
    CrossrefPubMedGoogle Scholar
  • 46 Radu CA, Schachner M, Tränkle M, Germann G, Sauerbier M. Functional results after wrist denervation [in German]. Handchir Mikrochir Plast Chir 2010; 42 (5) 279-286
    Article in Thieme ConnectPubMedGoogle Scholar
  • 47 Rhee PC, Moran SL, Shin AY. Association between lunate morphology and carpal collapse in cases of scapholunate dissociation. J Hand Surg Am 2009; 34 (9) 1633-1639
    CrossrefPubMedGoogle Scholar
  • 48 Bain GI, McGuire DT. Decision making for partial carpal fusions. J Wrist Surg 2012; 1 (2) 103-114
    Article in Thieme ConnectPubMedGoogle Scholar