Dry Wrist Arthroscopy: Technique and Rationale

Arthroscopic-assisted total wrist arthrodesis: surgical design and clinical outcomes

INTRODUCTION

This study presents an innovative arthroscopy-assisted total wrist arthrodesis technique utilising three hollow screws, aimed at improving clinical outcomes for patients with severe wrist arthritis.

MATERIALS AND METHODS

The technique involved the placement of three hollow screws to facilitate wrist bone fusion. Between August 2019 and August 2023, four patients diagnosed with severe wrist arthritis underwent the arthroscopy-assisted procedure. Each patient was followed postoperatively for at least 1 year. Clinical evaluations included the Visual Analogue Scale (VAS), the Quick Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire, and the Patient-Rated Wrist Evaluation (PRWE). Radiographic imaging was performed to confirm successful bone fusion. Postoperative complications and scar length were also recorded.

RESULTS

At the final follow-up, all patients exhibited decreased scores on the VAS, Quick DASH, and PRWE assessments, indicating reduced pain and improved wrist function. Radiographic imaging confirmed successful wrist bone fusion. No major complications arose, with an average scar length of 2.8 cm.

CONCLUSION

The novel arthroscopy-assisted total wrist arthrodesis technique offers a simple and minimally invasive method that effectively improves joint function and alleviates pain in patients with severe wrist arthritis, while reducing the risk of complications.

Wrist Arthroscopy: Positioning, Portal Placement, and Diagnostic Evaluation

Wrist arthroscopy can be an invaluable technique with both diagnostic and therapeutic utility for surgeons treating pathologies of the wrist. Its use has increased in recent years for a myriad of diagnoses. Understanding the foundations of the preparation for and performance of diagnostic arthroscopy is critical to the successful execution of arthroscopic treatment of pathologies of the wrist. This Technical Note aims to describe a reproducible surgical technique for wrist arthroscopy, including patient positioning, portal placements, and diagnostic evaluation.

Advancements in Diagnosis and Management of Distal Radioulnar Joint Instability: A Comprehensive Review Including a New Classification for DRUJ Injuries

Distal radioulnar joint (DRUJ) instability is a complex condition that can severely affect forearm function, causing pain, limited range of motion, and reduced strength. This review aims to consolidate current knowledge on the diagnosis and management of DRUJ instability, emphasizing a new classification system that we propose. The review synthesizes anatomical and biomechanical factors essential for DRUJ stability, focusing on the interrelationship between the bones and surrounding soft tissues. Our methodology involved a thorough examination of recent studies, incorporating clinical assessments and advanced imaging techniques such as MRI, ultrasound, and dynamic CT. This approach allowed us to develop a classification system that categorizes DRUJ injuries into three distinct grades. This system is intended to be practical for both clinical and radiological evaluations, offering clear guidance for treatment based on injury severity. The review discusses a range of treatment options, from conservative measures like splinting and physiotherapy to surgical procedures, including arthroscopy and DRUJ arthroplasty. The proposed classification system enhances the accuracy of diagnosis and supports more effective decision making in clinical practice. In summary, our findings suggest that the integration of advanced imaging techniques with minimally invasive surgical interventions can lead to better outcomes for patients. This review serves as a valuable resource for clinicians, providing a structured approach to managing DRUJ instability and improving patient care through the implementation of our new classification system.

Dry Knee Arthroscopy With Carbon Dioxide Insufflation for Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injuries are commonly treated through orthopaedic surgery, with traditional procedures relying on arthroscopy using fluid as the medium. However, dry arthroscopy has emerged as a potentially advantageous alternative technique. This method allows the knee joint to remain dry, reducing the risk of fluid leakage and enabling a more precise surgical visualization, resulting in shorter operation times and fewer complications. Recent research has highlighted the benefits of carbon dioxide (CO2) insufflation during ACL reconstruction, which can decrease pain and discomfort during early recovery. This article introduces a technique for performing ACL reconstruction that eliminates the need for arthroscopic fluid for visualization or instrumentation. Based on CO2 insufflation, this technique shows promise as a viable alternative to traditional fluid distention methods.

Diagnostic value of MRI in traumatic triangular fibrocartilage complex injuries: a retrospective study

BACKGROUND

Triangular fibrocartilage complex (TFCC) injuries commonly manifest as ulnar-sided wrist pain and can be associated with distal radioulnar joint (DRUJ) instability and subsequent wrist functional decline. This study aimed to assess the diagnostic value of MRI compared to wrist arthroscopy in identifying traumatic TFCC injuries and to determine the distribution of different TFCC injury subtypes in a normal clinical setting.

METHODS

The data of 193 patients who underwent both preoperative wrist MRI and wrist arthroscopy were retrospectively reviewed. The analysis focused on the proportion of subtypes and the diagnostic value of MRI in traumatic TFCC injuries, utilizing Palmer's and Atzei's classification with wrist arthroscopy considered as the gold standard.

RESULTS

The most prevalent subtype of TFCC injuries were peripheral injuries (Palmer 1B, 67.9%), followed by combined injuries (Palmer 1 A + 1B, 14%; Palmer 1B + 1D, 8.3%). Compared with wrist arthroscopy, the diagnostic sensitivity, specificity, negative predictive value (NPV), and Kappa value of MRI was as follows: traumatic TFCC tears 0.99 (95% CI: 0.97-1), 0.90 (0.78-0.96), 0.97 (0.87-1), and 0.93; styloid lamina tears 0.93 (0.88-0.96), 0.53 (0.30-0.75), 0.47 (0.26-0.69), and 0.44; and foveal lamina tears 0.85 (0.74-0.92), 0.38 (0.29-0.49), 0.79 (0.65-0.89), and 0.21.

CONCLUSIONS

The diagnostic value of MRI in traumatic TFCC injuries has been confirmed to be almost perfect using Palmer's classification. In more detailed classification of TFCC injuries, such as pc-TFCC tears classified by Atzei's classification, the diagnostic accuracy of MRI remains lower compared to wrist arthroscopy. Radiological associated injuries may offer additional diagnostic value in cases with diagnostic uncertainty.

Arthroscopy Journal: Reflections on 2023 and Auld Lang Syne

Auld lang syne; times long past. We were unsuspecting of the coming pandemic. Things changed. COVID-19 impacted each of us, our families, our patients, our medical practices, and our daily lives. The year 2020 was one of cancellation and loss; 2021 and 2022 were years of adaptation, caution, and continued loss. Finally, 2023 began a time of recovery; while COVID-19 is still with us, the pandemic has been declared ended, and we emerge with gratitude. We slowly removed our masks and rediscovered the vitality of meeting face-to-face. And throughout, Arthroscopy has continued to develop, including new journals; special issues on rehabilitation, biologics, and diversity as they relate to musculoskeletal care; collaboration with the American Board of Orthopaedic Surgery, Maintenance of Certification, Web-Based Longitudinal Assessment Pathway; Arthroscopy Techniques; Infographics; Visual Abstracts; and Podcasts. At year end, we extend special thanks to editors whose terms have expired, our team and leaders, our reviewers, our authors and readers, and our patients who offer us their trust and an opportunity to serve.