Intra-articular Synovial Ganglion of the Wrist.

Synovial ganglions, common soft tissue tumors of the hand and wrist, typically occur in the dorsal and volar aspects of the wrist, but intra-articular cases are rare. We present a case of a 27-year-old equestrian with persistent left wrist pain who was diagnosed with an intra-articular radiocarpal synovial ganglion after failed conservative management. Arthroscopic resection led to complete resolution of symptoms and functional recovery.

Front-to-Back Arthroscopic Repair of Complete Lunotriquetral Ligament Injuries: A Case Presentation and Algorithm for Arthroscopic Management of Intercarpal Ligament Injuries.

The lunotriquetral intercarpal ligament (LTIL) is an important structure that equalizes the forces on the lunate imparted through the scapholunate intercarpal ligament. The extension moment of the triquetrum balances the flexion force of the scaphoid, positioning the lunate for efficient load transfer from the hand to the wrist. In contrast to the scapholunate intercarpal ligament, the LTIL is strongest volarly, with the most critical region being associated with the volar ulnocapitate ligament.

Arthroscopic Versus Open Bone Grafting and Internal Fixation of Scaphoid Nonunion-A Systematic Review.

Background: Scaphoid nonunion often requires surgical management involving the combination of a bone graft and internal fixation to restore the carpal alignment and length. While traditionally, the scaphoid waist nonunions have been treated with open bone grafts, with the advent of arthroscopy, bone graft reconstruction can now be carried out as an arthroscopic assisted minimally invasive procedure. We aimed to compare outcomes between open and arthroscopic bone grafting in the treatment of scaphoid nonunion.

tREatment of trIaNgular FibrOcaRtilage ComplEx Ruptures (REINFORCER): protocol for randomised, controlled, blinded, efficacy trial of triangular fibrocartilage complex tears.

Introduction: Triangular fibrocartilage complex (TFCC) tear is often considered to be the cause of ulnar wrist pain. The primary treatment typically involves non-operative methods; however, in cases of persistent symptoms, operative intervention has been proposed as a viable option. Depending on the tear's morphology, treatment may involve debridement (central or radial tear) or repair (peripheral tear).

Arthroscopic algorithm for acute traumatic triangular fibrocartilage complex (TFCC) tears.

The triangular fibrocartilage complex (TFCC) is crucial for stability and acts as a shock absorber and load transmitter at the distal radioulnar joint (DRUJ). It is often injured in wrist trauma, particularly in young athletes. Clinical assessment involves patient history, physical examination, and imaging modalities like MRI, with wrist arthroscopy as the gold standard for diagnosing TFCC tears.

Arthroscopy Treatment of Scaphoid Pseudarthrosis: Description of the Technique and Case Series.

 To describe the procedure and evaluate the results of a series of patients with stable and unstable pseudarthrosis of the scaphoids treated with the use of arthroscopy associated with cancellous bone graft and compression screw.  Twenty-three patients were treated with this technique. The minimum postoperative follow-up was 12 months, and pre- and postoperative functional, clinical, and imaging analyses were performed.

Symptomatic Recurrent Instability of the Distal Radioulnar Joint After TFCC Repair in Patients With Ulnar-sided Wrist Pain May Be Related to Generalized Laxity.

An unstable distal radioulnar joint (DRUJ) can cause ulnar sided wrist pain. Stability of the DRUJ, which varies among individuals, is dependent on the bony structure of the sigmoid notch and the surrounding soft tissues, such as the interosseous membrane, the ECU tendon, the pronator quadratus, and the deep radioulnar ligaments (RUL). In particular, avulsions of the RUL lead to instability and disturbed wrist proprioception.

Reverse Wafer Procedure.

 This study aimed to present the results of an alternative technique for treating ulnar impaction syndrome, the "reverse wafer procedure," and assess the mid-term clinical outcomes of patients treated with this technique.  A retrospective evaluation was conducted on 14 patients who underwent the reverse wafer procedure for ulnar impaction syndrome between 2013 and 2020. The inclusion criteria for the study were persistent ulnar-sided wrist pain, even after a minimum of 3 months of nonoperative treatment, the presence of a chondral lesion on the lunate, and an intact triangular fibrocartilage complex (TFCC) based on arthroscopic evaluation.

Arthroscopic scaphocapitate fusion without bone graft; clinical and radiological outcomes.

Purpose: Scaphocapitate fusion (SCF) is an important surgical option for carpal pathologies, which are difficult to manage as Kienböck's disease. With the advantages of arthroscopy combined with percutaneous fixation techniques, arthroscopic scaphocapitate fusion can have the best outcome for the patient from a functional perspective. This study aims to evaluate the clinical, radiological, and functional results of arthroscopic SCF.

Description of Specific Portals for Extensor Carpi Ulnaris Tenoscopy: Anatomical Safety Study.

Purpose: The objective of this study was to describe potential working portals positioned directly over the extensor carpi ulnaris (ECU) tendon and assess their safety in relation to the dorsal branch of the ulnar nerve (DBUN).

Methods: A descriptive anatomical study was conducted on 15 fresh human cadaver upper limbs. Five distinct portals over the ECU were examined, and the shortest distances from these portals to the DBUN were measured.

Erratum: Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register.

We would like to inform of an error in the reported incidences in our published article, Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register. Specifically, the incidences for rotator cuff repair, partial meniscectomy, ankle arthroscopy, distal radius fracture fixation, and wrist arthroscopy surgeries were calculated using a too small population size. Accordingly, corrected calculations resulted in higher incidence values for these surgeries, impacting Table 3 and Figure 3, which now show accurate incidence rates.

Role of Synovectomy in Rheumatoid Hand and Wrist.

Synovectomy refers to the removal of all or part of the hypertrophied soft tissue membrane on the inside of the joint capsule or around tendons. Historically, this was typically performed for rheumatoid arthritis and other inflammatory conditions of the hand, but following the development of more advanced medical treatments, the role of synovectomy has come into question. In this article, the authors outline the biologic basis for synovectomy and then consider its present and future role in the management of joint and tendon disease, followed by what further research is needed.

Generalized Joint Laxity Increases the Risk of Recurrence of Distal Radioulnar Joint Instability after Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex.

Purpose: To compare the clinical results of the arthroscopic foveal repair of the triangular fibrocartilage complex (TFCC) for distal radioulnar joint (DRUJ) instability in patients with or without generalized joint laxity.

Methods: Patients who underwent arthroscopic transosseous foveal TFCC repair of Palmer 1B foveal TFCC tears (Atzei classification class II or III) from January 2018 to October 2021 were identified. Patients treated for symptomatic DRUJ instability for more than 3 months, and with at least 2 years of follow-up, were included.

Round table discussion. The management of proximal scaphoid nonunion.

The management of scaphoid nonunion, although relatively common, continues to pose challenges, especially if complicated by avascular necrosis of the proximal pole, humpback or dorsal intercalated segment instability deformities, and early scaphoid nonunion advanced collapse. In this round table article, four surgeons were asked to answer key questions on a clinical example of a proximal scaphoid nonunion to outline their approach and rationale in their preferred treatment choices. The current panel of experts leans towards arthroscopic methods of treatment and most agree that arthroscopic bone grafting has become an important and revolutionary treatment option, which has yielded excellent results.

Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report.

Rationale: The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling.

Patient Concerns: A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method.

Management of Extra-Articular and Intra-Articular Distal Radius Malunion.

This article presents a comprehensive overview of managing extra-articular and intra-articular distal radius malunions (DRM), discussing the pathoanatomy, clinical, and radiologic evaluation, conservative treatment, and surgical strategies. Corrective osteotomy remains the primary surgical intervention for symptomatic DRM. Surgical planning should consider factors such as timing, approach, correction technique, implant, graft, and associated injuries.

Is the ulnar fovea sign positive only in foveal tears of the triangular fibrocartilage complex?

A positive ulnar fovea sign is usually considered to be specific for foveal disruption of the distal radioulnar ligaments. A retrospective review was done of 73 patients with a positive ulnar fovea sign. Only 21 patients had a foveal tear on arthroscopic examination.

Regional variation in low-value musculoskeletal surgery: a nationwide study from the Finnish Care Register.

Background And Purpose: Healthcare systems globally are grappling with resource constraints and rising costs. Concerns have been raised about "low-value" care, which consumes healthcare resources without benefiting patients. We aimed to examine regional differences in common low-value musculoskeletal surgeries in Finland and explore explanatory factors behind the variation.

Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease.

 The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results.  Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs.

Over-the-Top Foveal Triangular Fibrocartilage Complex Repair.

There are many techniques that address triangular fibrocartilage complex foveal injuries, which are typically performed with an outside to inside technique. In this article, we describe an inside to outside triangular fibrocartilage complex repair technique that may result in more accurate suture passage and mitigate the risk of fracture from ulna tunnels.

Introducing Foundations of Arthroscopy Techniques.

Arthroscopy Techniques is home to technical notes with video on all methods and procedures arthroscopic or related at https://www.arthroscopytechniques.org and https://www.