Revista Espa?ola de Artroscopia y Cirugía Articular最新文献

To perform a safe and effective wrist arthroscopy requires knowledge of the anatomy of the region, as well as the existence and precise location of the arthroscopic portals that must be used. A general configuration, the performing and location of the arthroscopic portals, the anatomical structures that can be visualized through them, as well as the at-risk structures that must be avoided in all wrist arthroscopies, are presented in this chapter.

Scapholunate instability is the most common instability of the carpal and covers a wide spectrum of lesions, from a partial scapholunate ligament injury to it complete injury associated with a lesion of the secondary stabilizers. It has usually been classified into pre-dynamic, dynamic and static injury depending on the radiographic findings on the simple and dynamic X-rays. Despite all this, radiological tests have a high percentage of false negatives, thus the “gold standard” technique for the diagnosis of these injuries is, without a doubt, wrist arthroscopy. In this article, as review of the different classifications of scapholunate instability is presented, along with other useful arthroscopic examinations to help in the assessment of this condition described by the authors.

There are numerous techniques available for the arthroscopic treatment of scapholunate instability, and this article will present a review of the most extensively used techniques such as, debridement, electrocoagulation, reduction-association scapholunate (RASL) procedure, and capsuloligamentous suture. Special mention is made to arthroscopic ligamentoplasty, described by the authors, that enables the dorsal and volar reconstruction of the scapholunate ligament.

Ulnocarpal impaction is one of the most common causes of ulnar-sided wrist pain. It is a progressive degenerative condition caused by chronic impaction of the ulnar head against the triangular fibrocartilage (TFC) and the ulnar portion of the carpus. The aim of surgical treatment is to perform a decompression of the ulnar column of the wrist, in the ulnocarpal joint.

With the advances in wrist arthroscopic surgery it is possible to shorten the ulnar head (Wafer procedure) by an arthroscopic approach, at the same time as assessing and treating the injuries associated with the ulnar impaction (TFC injuries, chondral injuries, lunopyramidal ligament tears, synovitis, etc.), thus allowing a more complete and accurate treatment, and with some very satisfactory results.

After a short anatomy and biomechanics review, the various triangular fibrocartilage complex injuries are defined, both from an anatomical-topographical and functional point of view. After presenting the general principles of the arthroscopic treatment of the wrist, a review is made of the specific surgical techniques recommended for each type of injury, as well as the appropriate post-operative measures. To do this, a review has been made of the classifications and treatments proposed by EWAS (European Wrist Arthroscopy Society), and some final touches have been added by the author based on personal experience.

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  Evidence level: 5.

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  Clinical relevance: triangular fibrocartilage complex injuries represent one of the most frequent sources (but not the only ones) of ulnocarpal wrist pain. A large percentage of wrist arthroscopies are performed that are indicated for their treatment. An in-depth knowledge of their anatomy and biomechanics, as well as the types of treatment indicated in each case, will have a positive benefit for the patients.

The aim of this article is to describe the indications and arthroscopic techniques currently in use for the treatment of scapholunate advanced collapse (SLAC) wrist and scaphoid nonunion advanced collapse (SNAC) wrist. These techniques, up until now, and in the hands of expert surgeons, appear to provide results at least similar to those obtained in open surgery techniques.

To determine the cause of ulnar wrist pain is not always easy, due to the complexity of the anatomy and its biomechanical characteristics.

Osteochondritis of the proximal pole of the hamate bone is a possible cause of ulnar wrist pain and we must take into account in our differential diagnosis. Wrist arthroscopy has become a necessary and essential tool for the study, diagnosis, and treatment of wrist joint pathology.

Partial arthrodesis of the carpal is an alternative technique for the treatment of posttraumatic arthritic, degenerative, or rheumatic disease. The aim of this type of surgery is the resolution of the painful symptoms and preserving the mobility of the healthy joints. Performing these techniques by arthroscopic surgery gives similar results to those obtained with open surgery, as well as minimizing some of the complications of the latter.