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J Wrist Surg 2024; 13(04): 310-317
DOI: 10.1055/s-0043-1769934
Scientific Article

Arthroscopic Debridement for Treatment of Chronic Dynamic Scaphoid Instability

Cyrus Steppe 
1   University of Texas Southwestern Medical School, Dallas, Texas
,
Houshang Seradge 
2   Department of Hand Surgery, Seradge Medical, Oklahoma City, Oklahoma
,
Winfred Parker
2   Department of Hand Surgery, Seradge Medical, Oklahoma City, Oklahoma
,
Carrie Seradge 
2   Department of Hand Surgery, Seradge Medical, Oklahoma City, Oklahoma
,
Kian Steppe 
2   Department of Hand Surgery, Seradge Medical, Oklahoma City, Oklahoma
,
Kamran Steppe 
2   Department of Hand Surgery, Seradge Medical, Oklahoma City, Oklahoma
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Abstract

Background There is a paucity of information on minimal surgical intervention for the treatment of chronic dynamic scaphoid instability (CDSI) that will achieve an acceptable mid-term result.

Purpose We hypothesize that by following a debride-first-then-wait protocol, some patients with CDSI can be treated with arthroscopic debridement alone and avoid a reconstructive procedure.

Patients and Methods We performed a retrospective, longitudinal study from January 2008 to December 2018 of all patients diagnosed with CDSI and treated with arthroscopic debridement of the scapholunate interosseous ligament. In all cases, a debride-first-then-wait protocol was followed that included a predetermined wait period after arthroscopic debridement, giving the patient a chance to experience possible symptom improvement. This approach integrated the patient's perceived wellness into the decision-making process. All wrists that remained symptomatic or experienced recurrence of symptoms were treated with a reconstructive procedure. The wrists were divided into two groups: arthroscopic debridement only (ADO) and reconstructive procedure (RP).

Results Seventy-nine wrists (72 patients) of 191 consecutive wrist arthroscopies met the inclusion criteria. The ADO group consisted of 43 wrists (54%). An average of 6.3 years later (range: 2–11 years), these patients remained satisfied with the results of the arthroscopic debridement and did not want further treatment. The RP group included 36 wrists (46%) with 91.7% of reconstructive surgeries occurring within 6 months of the arthroscopy. With a mid-term follow-up, 75% of Geissler grade II ligament tears, 48% of grade III tears, and 39% of grade IV tears were successfully treated with arthroscopic debridement alone and avoided a reconstructive surgery.

Conclusion By adopting a debride-first-then-wait protocol, some patients with CDSI can be treated with a more limited intervention, arthroscopic debridement. In this series, 54% of wrists with CDSI avoided a reconstructive surgery for an average of 6.3 years.

Type of Study / Level of Evidence Case Series, Level IV.

Keywords

carpal instability - Dynadesis - dynamic scaphoid instability - scapholunate - SLIL - wrist arthroscopy - treatment

Ethical Review Committee Statement

IRB approval was obtained.


Note

The work was performed at: Seradge Medical, 13100N Western Avenue, Suite 200, Oklahoma City, OK 73114, United States.




Publication History

Received: 31 January 2023

Accepted: 09 May 2023

Article published online:
17 August 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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