Preventable Repeat Wrist Arthroscopies

Abstract

Objective: To evaluate indications and reasons for repeat wrist arthroscopies to identify preventable cases. Materials and Methods: For this retrospective, 2-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by their underlying pathologies (lesions of the central or peripheral part of the triangular fibrocartilage complex [TFCC], scapholunate (SL) ligament, cartilage, septic or aseptic arthritis) and by the causes that necessitated repeat arthroscopies (insufficient preoperative diagnostics, insufficient documentation at primary arthroscopy, uncertainty of diagnosis despite previous arthroscopy, progress of the underlying disease, recurrent symptoms after primary successful treatment). Results: Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar TFCC avulsions, the remaining 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic arthroscopy prior to therapeutic arthroscopy in 49 (37%) wrists, 48 of which had TFCC pathologies, while the remaining had a SL ligament lesion. Uncertainty of diagnosis despite previous arthroscopy led to another 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a suspected central TFCC lesion, and 2 for uncertainty concerning the integrity of the SL ligament. Inadequate photo or video documentation necessitated arthroscopic reassessment of the cartilage in 16 (12%) wrists. Conclusions: In this series, 2 out of 3 revision arthroscopies could potentially have been prevented. The inconsequent use of available modern magnetic resonance imaging (MRI) techniques and the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures.