Scapholunate Advanced Collapse Research Articles

Intra Articular Injection of Autologous Microfat and Platelets-Rich Plasma in the Treatment of Wrist Osteoarthritis: A Pilot Study.

No injection treatment has been proven to be effective in wrist osteoarthritis. When conservative measures fail, its management involves invasive surgery. Emergence of biotherapies based on adipose derived stem cells (ADSC) offers promising treatments for chondral degenerative diseases. Microfat (MF) and platelets-rich plasma (PRP) mixture, rich in growth factors and ADSC could be a minimally invasive injectable option in the treatment of wrist osteoarthritis. The aim of this uncontrolled prospective study was to evaluate the safety of a 4 mL autologous MF-PRP intra-articular injection, performed under local anesthesia. The secondary purpose was to describe the clinical and MRI results at 12 months of follow-up. Patients’ data collected were: occurrence of adverse effects, Visual analog scale (VAS), Disabilities of the Arm, Shoulder and Hand score (DASH) and Patient-Rated Wrist Evaluation (PRWE) scores, wrist strength, wrist range of motion and 5-level satisfaction scale. No serious adverse event was recorded. A statistically significant decrease in pain, DASH, PRWE and force was observed at each follow-up. Our preliminary results suggest that intra-articular autologous MF and PRP injection may be a new therapeutic strategy for wrist osteoarthritis resistant to medical symptomatic treatment prior to surgical interventions.

Arthroscopic Radiocarpal Tendinous Inter-Position for Grade 2 Scapholunate Advanced Collapse - Surgical Technique.

Grade 2 scapholunate advanced collapse (SLAC 2) can be treated by proximal row carpectomy with satisfactory results. However, this method is invasive and can limit function. The senior author had proposed an arthroscopic alternative with tendon interposition between the radius and proximal carpal row (arthroscopic interposition tendon arthroplasty [AITA]). However, this arthroscopic technique is technically difficult and requires a risky palmar arthroscopic portal. We report a modification of AITA, the one-loop arthroscopic radiocarpal tendon inter-position (1L-ARTI) that is simpler and needs only dorsal arthroscopic portals. Level of Evidence: Level V (Therapeutic).

Does indocyanine green fluorescence angiography impact the intraoperative choice of procedure in free vascularized medial femoral condyle grafting for scaphoid nonunions?

BackgroundFree vascularized medial femoral condyle (MFC) bone grafts can lead to increased vascularity of the proximal pole and restore scaphoid architecture in scaphoid nonunions. The intraoperative perfusion assessment of the bone graft is challenging because the conventional clinical examination is difficult. Indocyanine green (ICG) angiography has previously been shown to provide a real-time intraoperative evaluation of soft tissue perfusion in reconstructive surgery. The present study investigated the utility of ICG angiography in patients treated with a free medial femoral condyle graft for scaphoid nonunions.MethodsWe performed a retrospective analysis of patients with scaphoid nonunions, in which ICG angiography was used intraoperatively for perfusion assessment. The medical records, radiographs, intraoperative imaging, and operative reports of all patients were reviewed. Intraoperative ICG dye was administered intravenously, and laser angiography was performed to assess bone perfusion. The scaphoid union was examined using postoperative CT scans.ResultsTwo patients had documented osteonecrosis of the proximal pole at the time of surgery. Four patients received a nonvascularized prior bone graft procedure, and a prior spongiosa graft procedure was performed in one patient. The mean time from injury to the MFC bone graft surgery was 52.7 months, and the mean time from prior failed surgery was 10.4 months. Perfusion of the vascular pedicle of the MFC and the periosteum could be detected in all patients. In two patients, even perfusion of the cancellous bone could be demonstrated by ICG angiography. Following transplantation of the bone graft, patency of the vascular anastomosis and perfusion of the periost were confirmed by ICG angiography in the assessed cases. No additional surgery regarding a salvage procedure for a scaphoid nonunion advanced collapse was necessary for the further course.ConclusionICG-angiography has shown to be a promising tool in the treatment of scaphoid nonunion with medial femoral condyle bone grafts. It enables intraoperative decision making by assessment of the microvascular blood supply of the periosteum and the vascular pedicle of the MFC bone graft. Further studies need to evaluate the impact on union rates in a long-term follow-up.

Relationship Between Preoperative and Postoperative Motion After Four-Corner Wrist Fusion for Osteoarthritis: Clustering and Regression Analyses

Four-corner fusion (4CF) is a surgical option for refractory scapholunate advanced collapse and scaphoid nonunion advanced collapse wrist arthritis. Preoperative range of motion (ROM) predicts outcomes in many orthopedic procedures. This study investigates ROM in a cohort of 4CF patients to examine the relationship between preoperative and postoperative motion and identifies different clinical patterns. We performed a retrospective review of 4CF patients. Patients with a history of inflammatory arthritis and radiographic characteristics of inflammation were excluded. Demographics, prior wrist surgery history, and ROM data were collected at preoperative and postoperative intervals after cast removal at 8 weeks, 3 months, and 8 months. Regression analysis compared the motion before and after 4CF. Subsequent cluster analysis to reduce confounding compared postoperative motion differences in the top 20% to the bottom 20% of patients by preoperative motion. We included 148 patients; 27 had prior surgery on the ipsilateral wrist. Preoperative arc averaged 86° ± 28° (flexion 46° ± 17°, extension 40° ± 15°); 8-week arc 43° ± 19° (flexion 19° ± 12°, extension 24° ± 12°); 3-month arc 62° ± 17° (flexion 30° ± 12°, extension 32° ± 11°); and 8-month arc 74° ± 17° (flexion 36° ± 11°, extension 37° ± 12°). Preoperative and final arcs were (r= 0.39). Clustering by the preoperative arc, the top 20% (mean 124° ± 15°) achieved a mean final arc of 81° ± 16°, while the bottom 20% (mean 47° ± 16°) achieved a mean final arc of 65° ± 19°. Intercluster differences were statistically significant. The bottom 20% gained motion postoperatively. Most patients in the middle 60% did not differ significantly in postoperative motion. Although wrist motion following 4CF correlates positively with preoperative motion, most patients do not differ significantly in postoperative motion. Patients with substantial preoperative motion deficits gain motion after 4CF. This information is important when counseling patients, determining the timing of surgical intervention, and managing expectations related to motion outcomes. Prognostic II.

Arthroscopy-assisted bone grafting for the treatment of SNAC stage I without radial styloidectomy.

To report the clinical and radiological outcomes of arthroscopic bone grafting and percutaneous K-wire fixation without radial styloidectomy in patients with scaphoid nonunion advanced collapse (SNAC).We retrospectively analyzed the records of 15 patients with SNAC who were treated with arthroscopic bone grafting and percutaneous K-wire fixation and subsequently followed up for a minimum of 1 year between November 2009 and March 2018. The clinical outcomes were evaluated by comparing the range of motion (ROM), grip strength, the modified Mayo Wrist Score, and visual analog scale (VAS) scores for pain, all of which were measured preoperatively and at the last follow-up. The radiologic outcomes were evaluated by comparing the scapholunate (SL) and radiolunate (RL) angles preoperatively and at the last follow-up.All 15 cases of nonunion were resolved. The average radiologic union time was 9.7 ± 1.2 weeks. The average VAS score increased from 5.7 ± 2.3 (range, 2 − 10) preoperatively to 1.3 ± 1.3 (range, 0 − 3) at the last follow-up (P < .05). The average modified Mayo wrist score increased from 58.3 ± 14.0 preoperatively to 80.0 ± 9.2 at the last follow-up (P < .05). The mean ROM of the wrist improved, but there was no statistical significance. At the last follow-up, the mean flexion and radial deviation on the affected side were significantly decreased, and the mean extension on the affected side was significantly improved compared to the normal side (P < .05). The mean preoperative SL and RL angles were 66 ± 11.9° and 7.2 ± 6.8°, respectively, and were decreased to 50.4 ± 7.5° and 6.4 ± 5.2°, respectively, at the last follow-up. The mean SL angle was significantly corrected (P = .01).Arthroscopic bone grafting and percutaneous Kerschner (K)-wire fixation without radial styloidectomy are considered to be very effective methods for correcting scaphoid deformities to treat SNAC stage I. However, caution may be needed during the surgery to prevent reductions in flexion and the radial deviation of the wrist.

Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up

Treatment of Scaphoid Nonunion Advanced Collapse Stage III with Proximal Row Carpectomy and Resurfacing of Capitate with Pyrocarbon Implant - Results of 2-Year of Follow-Up

The impact of psychological factors on outcome after salvage surgery for wrist osteoarthritis.

This prospective longitudinal study of 80 patients analysed the effect of preoperative pain catastrophizing, anxiety, depression and sense of coherence on the Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, quality of life, grip strength and range of motion during the first year after salvage surgery for wrist osteoarthritis. Generalized estimating equations were used to analyse the effect of the psychological factors on the outcome variables. Pain catastrophizing or a tendency for anxiety preoperatively had a strong negative impact on postoperative Disabilities of the Arm, Shoulder and Hand and Patient-Rated Wrist Evaluation. Anxiety also predicted a lower postoperative quality of life, whereas pain catastrophizing had a negative impact on grip strength. Sense of coherence did not influence the outcome.Level of evidence: II

Psychometric properties of patient-reported outcome measures (PROMs) in wrist osteoarthritis: test–retest reliability and construct validity

BackgroundPatient-reported outcome measures (PROMs) are frequently used to assess the effects of treatments in patients with wrist osteoarthritis (OA), but their psychometric properties have not been evaluated in this group of patients. Our aim was to evaluate the psychometric properties of the Numeric Rating Scale (NRS pain at rest, pain on motion without load, and pain on load), the Disabilities of the Arm, Shoulder and Hand (DASH) and the Patient Rated Wrist Evaluation (PRWE) questionnaires in patients with wrist OA regarding test–retest reliability and construct validity.MethodsThe NRS, DASH and PRWE were self-administered by 50 patients (40 men and 10 women, mean age 66 years) in a postal survey on two occasions, two weeks apart. Test–retest reliability was evaluated by Kappa statistics and the Spearman rank correlation coefficients (rho) were calculated to evaluate construct validity.ResultsThe Kappa coefficients for DASH, PRWE and NRS pain on motion without load and NRS pain on load were > 0.90, 95% CI ranging from 0.84 to 0.98, while NRS pain at rest was 0.83, 95% CI 0.73–0.92. The construct validity of the PROMs was confirmed by three formulated hypotheses: a higher correlation between PRWE and NRS (rho 0.80–0.91, p < 0.001) was found, compared to DASH and NRS (rho 0.68–0.80, p < 0.001); the NRS pain on motion without load and NRS pain on load correlated more strongly to PRWE and DASH (rho 0.71–0.91, p < 0.001) compared to NRS pain at rest (rho 0.68–0.80) and a high correlation between PRWE and DASH was found (rho 0.86, p < 0.001).ConclusionsThe NRS, DASH and PRWE demonstrate excellent test–retest reliability and moderate to high construct validity in patients with wrist OA. These PROMs are highly related, but they also differ. Therefore, they complement each other in ensuring a comprehensive evaluation of perceived disability in wrist OA. As PRWE showed the highest test–retest reliability and the highest relation to the other PROMs, the sole use of the PRWE can be recommended in clinical practice.

Does Midcarpal Joint Structure Affect Development of Arthritis in the Wrist.

Background Degenerative wrist arthritis develops in specific patterns because of forces acting on existing structural configurations. The most common pattern of wrist osteoarthritis is scapholunate advanced collapse (SLAC). Other patterns include isolated scaphotrapezial trapezoid (STT) joint and isolated midcarpal or radiolunate joint arthritis. One predictor of degeneration pattern is the structure of the wrist. Questions/Purposes Our purpose was to evaluate the relationship between midcarpal joint structure and the pattern of degenerative arthritis. We hypothesized that a wrist type 2 will preferentially develop SLAC degeneration. Patients and Methods We retrospectively evaluated 195 degenerative wrist radiographs. Radiographs were reviewed for lunate/wrist type, degeneration pattern, ulnar variance, radial and volar tilt, inclination, carpal height, scapholunate angle, gap, and presence of thumb carpometacarpal (CMC) joint, STT joint, and midcarpal joint arthritis. Results We had 158 radiographs with SLAC degeneration and 37 with atypical patterns, 154 type 2 and 41 type 1 wrists. There was a significant correlation between wrist type and the pattern of wrist degeneration ( p = 0.02). SLAC degeneration developed in wrists with type 2 lunate while isolated midcarpal arthritis was associated with type 1 wrist. Isolated midcarpal joint arthritis was associated with STT arthritis, p < 0.01. Radial height, inclination, volar tilt, and ulnar variance, and scapholunate gap and angle were not associated with wrist type. Ulnar variance was associated with thumb CMC and STT joint arthritis while radial height was associated with isolated midcarpal joint arthritis. Conclusion This study found significant relationships between midcarpal joint structure and pattern of degeneration. This contributes to understanding the development of degeneration and can aid in future prevention of arthritis. Level of Evidence This is a Level IV, diagnostic study.

Total Wrist Arthroplasty for Posttraumatic Wrist Osteoarthritis: A Cohort Study Comparing Three Indications.

Scapholunate ligament ruptures and scaphoid nonunion with consecutive advanced collapse (SLAC and SNAC wrists) as well as intra-articular distal radius fractures (DRF) are prone to cause posttraumatic wrist osteoarthritis. The aim of this study was to compare the outcomes of these indications for total wrist arthroplasty. We included 13, 11, and 8 patients with an overall mean age of 60 ± 9 years in the SLAC, SNAC, and DRF cohort, respectively. After an average follow-up period of 6 ± 3 years, we found no difference between our groups regarding pain levels and functional scores, although these parameters significantly improved compared to preoperative parameters. Complication and revision rates revealed no significant difference. However, significantly higher extension, arc of range of motion values in the flexion-extension, as well as in radial-ulnar deviation plain were detected in the SLAC compared to the DRF group. Finally, TWA proved to show a beneficial performance in all three investigated indications.

Two-Corner Fusion or Four-Corner Fusion of the Wrist for Midcarpal Osteoarthritis? A Multicenter Prospective Comparative Cohort Study.

Midcarpal osteoarthritis is a debilitating wrist pain, and a mainstay treatment is midcarpal fusion. The accepted standard for midcarpal fusion is four-corner fusion, but lately, two-corner fusion (i.e., capitolunate fusion) has gained popularity. This is the first prospective, multicenter, cohort study comparing capitolunate fusion with four-corner fusion for midcarpal osteoarthritis. Patients with scaphoid nonunion advanced collapse or scapholunate advanced collapse wrist of grade 2 to 3 undergoing capitolunate fusion or four-corner fusion between 2013 and 2019 were included. Sixty-three patients (34 with capitolunate fusion, 29 with four-corner fusion) were included. Patient demographics were similar between groups. Patient-Rated Wrist Hand Evaluation questionnaire score, visual analog scale pain score, grip strength, range of motion, and complications were measured at baseline and 3 months and 12 months postoperatively. Complications (i.e., nonunion, hardware migration, conversion to wrist arthrodesis, or arthroplasty) were determined. A significant difference in Patient-Rated Wrist Hand Evaluation or visual analog scale pain score at 3 and 12 months postoperatively between the capitolunate fusion and four-corner fusion groups was not found. There were no differences in grip strength between patient groups preoperatively or 12 months postoperatively. At 12 months postoperatively, capitolunate fusion patients had better flexion compared with that in the four-corner fusion group (p = 0.002); there were no differences in complications and reoperation rates between groups. Capitolunate fusion and four-corner fusion were comparable in terms of functional scores (i.e., Patient-Rated Wrist Hand Evaluation and visual analog scale pain scores) and complication scores. Capitolunate fusion showed favorable wrist mobility compared with four-corner fusion in treatment of midcarpal osteoarthritis. Capitolunate fusion advantages include use of less material, less need for bone-graft harvesting, and easier reduction of the lunate during fixation. Therapeutic, II.

The effects of partial wrist denervation in wrist osteoarthritis: patient-reported outcomes and objective function.

This prospective longitudinal study aimed to analyse the effect of partial wrist denervation on patient-reported outcomes, quality of life and objective function in symptomatic wrist osteoarthritis during the first year after surgery. Sixty consecutive patients underwent an anterior and posterior interosseous neurectomy during 2018–2020. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation, EuroQol-5D-3L, pain at rest and on load, and objective function were assessed preoperatively and 3, 6 and 12 months postoperatively. Generalized estimating equations were used to analyse the effect on the outcome variables. Disabilities of the Arm, Shoulder and Hand, Patient-Rated Wrist Evaluation and pain scores improved significantly postoperatively with no decline over time, but no patient reported outcome measure reached the minimal clinically important difference. Quality of life, strength and range of motion did not improve. We found no complications. Seventeen patients needed further surgery during the study period. More studies are needed to evaluate whether denervation is truly effective or not.Level of evidence: II

High results and lower cost in four-bone arthrodesis with retrograde screws.

Aim To describe the technique of the four-corner fusion with two retrograde crossed headless screws in cases of carpal collapse. Methods This technique is a consolidated procedure performed in cases of scaphoid non- union advanced collapse (SNAC) type II and III, scapholunate advanced collapse (SLAC) type II and III and in other cases of carpal collapse. Between 2017 and 2019 we treated six male patients (a mean age of 55.0 years) with radiocarpal osteoarthritis. Our technique involves the use of two retrograde crossed headless screws; the first screw was placed distally proximally from the uncinate to the lunate and the second screw from the pyramidal to the capitate, crossed at approximately 90 degrees. Clinical and radiographic two-year follow-up was performed. Before the treatment and during the follow-ups VAS, PRWE and DASH Quick score scales, measured wrist range of motion (WROM) were administered and evaluated. Results In all cases the X-ray consolidation of arthrodesis within five months was noticed; in 50% patients already under 3-month control. No observed signs of mobilization of screws and inflammatory or infectious processes were found. All patients were satisfied (reduction/disappearance of pain). All surgically treated patients resumed normal daily activities. These improvements were confirmed by the results of the evaluation scale and clinical examination. Conclusion This technique, in our opinion, represents a gold standard. Its low costs of the material used (especially comparing to other technique), a low prevalence of complications of materials and fusion in 100% of cases should be also considered.

Management of Post-traumatic Wrist Arthritis With Proximal Row Carpectomy

Scaphoid nonunion advanced collapse and scapholunate advanced collapse are 2 common patterns of post-traumatic wrist arthritis that are treated with a proximal row carpectomy. A proximal row carpectomy is a technically simple, motion salvage procedure that provides good pain relief and reliable clinical outcomes in patients who have failed conservative measures in managing their pain from post-traumatic wrist arthritis. This article will provide a background on the indications for use of this technique, summarize the clinical outcomes and provide a detailed surgical technique on performing the procedure.

Partial Wrist Denervation for Management of Post-traumatic Wrist Arthritis

Symptomatic post-traumatic wrist osteoarthritis can occur after distal radius or carpal fractures or ligamentous injury and results in a predictable pattern of subsequent articular degeneration. Most commonly, this includes patients with radiocarpal arthritis after distal radius fracture, scaphoid nonunion advanced collapse and scapholunate advanced collapse. Patient can be considered for surgery after failure of at least 6 months of conservative treatments focusing on activity modification, splinting, oral anti-inflammatory medications or intra-articular corticosteroid injections. Multiple surgical options for the management of post-traumatic arthritis exists including carpectomy, partial or total arthrodesis, arthroplasty and denervation techniques. While partial or total wrist arthrodesis have demonstrated excellent outcomes with regards to pain, they are typically considered salvage options because of an associated loss of wrist motion. When compared to limited or total arthrodesis procedures, wrist denervation offers pain relief while preserving motion with shorter convalescent time and avoids potential complications associated with arthrodesis procedures including nonunion and need for subsequent revision surgery.

Long-term outcomes of the four-corner fusion of the wrist: A systematic review.

BACKGROUNDFour-corner fusion (4CF) is a motion sparing salvage procedure that is used to treat osteoarthritis secondary to advanced scapholunate collapse or longstanding scaphoid nonunion advanced collapse. Little is known about the long-term survivorship and outcomes of 4CF. AIMTo report on clinical and functional long-term outcomes as well as conversion rates to total wrist fusion or arthroplasty.METHODSThe systematic review protocol was registered in the international prospective register of systematic reviews (PROSPERO) and followed the PRISMA guidelines. Original articles were screened using four different databases. Studies with a minimum Level IV of evidence that reported on long-term outcome after 4CF with a minimum follow-up of 5 years were included. Quality assessment was performed using the Methodological Index for Non-Randomized Studies criteria.RESULTSA total of 11 studies including 436 wrists with a mean follow-up of 11 ± 4 years (range: 6-18 years) was included. Quality assessment according to Methodological Index for Non-Randomized Studies criteria tool averaged 69% ± 11% (range: 50%-87%). Fusion rate could be extracted from 9/11 studies and averaged 91%. Patient-reported outcomes were extracted at last follow-up from 8 studies with an average visual analog scale of 1 ± 1 (range: 0-2) and across 9 studies with an average Disabilities of the Arm, Shoulder and Hand score of 21 ± 8 (range: 8-37). At last follow-up, the cumulative conversion rate to total wrist fusion averaged 6%. There were no conversions to total wrist arthroplasty.CONCLUSIONThe 4CF of the wrist is a reliable surgical technique, capable of achieving a good long-term patient satisfaction and survivorship with low rates of conversion to total wrist fusion.

Outcomes of Arthroscopic Scaphoid Excision and Lunocapitate Fusion for Advanced Traumatic Arthritis of the Wrist.

Arthroscopic lunocapitate (LC) fusion can be an alternative surgical treatment for scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC) of the wrist. We retrospectively reviewed patients who had arthroscopic LC fusion to estimate clinical and radiological outcomes. From January 2013 to February 2017, all patients with SLAC (stage II or III) or SNAC (stage II or III) wrists, who underwent arthroscopic LC fusion with scaphoidectomy and were followed up for a minimum of 2 years, were enrolled in this retrospective study. Clinical outcomes included visual analog scale (VAS) pain, grip strength, active range of wrist motion, Mayo wrist score (MWS), and the Disabilities of Arm, Shoulder and Hand (DASH) score. Radiologic outcomes included bony union, carpal height ratio, joint space height ratio, and loosening of screws. We also performed group analysis between patients with 1 and 2 headless compression screws to fix the LC interval. Eleven patients were assessed for 32.6 ± 8.0 months. Union was achieved in 10 patients (union rate, 90.9%). There was improvmenet in mean VAS pain score (from 7.9 ± 1.0 to 1.6 ± 0.7, p = 0.003) and grip strength (from 67.5% ± 11.4% to 81.8% ± 8.0%, p = 0.003) postoperatively. The mean MWS and DASH score were 40.9 ± 13.8 and 38.3 ± 8.2, respectively, preoperatively and improved to 75.5 ± 8.2 and 11.3 ± 4.1, respectively, postoperatively (p < 0.001 for all). Radiolucent screw loosening occurred in 3 patients (27.3%), including 1 nonunion patient and 1 patient who underwent screw removal due to the screw migration encroaching the lunate fossa of radius. In group analysis, only the frequency of radiolucent loosening was higher in 1 screw (3 of 4) than 2 screw fixation (0 of 7) (p = 0.024). Arthroscopic scaphoid excision and LC fusion for patients with advanced SLAC or SNAC of the wrist was effective and safe only in cases fixed with 2 headless compression screws. We recommend arthroscopic LC fusion using 2 screws rather than 1 to decrease radiolucent loosening, which might affect complications such as nonunion, delayed union, or screw migration.

Preoperative and Postoperative Imaging of Scapholunate Ligament Primary Repair and Modified Brunelli Reconstruction.

Injury of the scapholunate ligament (SLL) complex can lead to scapholunate dissociation, characterized by scapholunate interval widening and volar rotary subluxation of the scaphoid. Loss of the mechanical linkage between the scaphoid and lunate results in carpal instability and eventual scapholunate advanced collapse (SLAC) arthropathy. SLL complex injuries vary from acute and traumatic to chronic and degenerative. A staging system can be used to guide treatment options for these injuries on the basis of the reparability of the SLL dorsal band, carpal alignment and malalignment reducibility, and cartilage damage. Preoperative imaging with radiography and MRI is a component of injury staging and aids in planning surgical procedures. If the SLL dorsal band is reparable, then direct primary ligament repair with dorsal capsulodesis or dorsal intercarpal (DIC) ligament transfer can be performed. If the SLL dorsal band is irreparable with normal alignment or reducible malalignment, then reconstruction can be performed. In the setting of irreducible malalignment or SLAC arthropathy, a salvage procedure can be performed. Knowledge of SLL primary repair and various reconstruction techniques is important not only when evaluating postoperative images but also for accurate description of SLL injuries and aiding the surgeon in treatment planning. The authors present the normal anatomy of the SLL complex, a staging classification of SLL injury with radiographic and MRI findings, and common surgical procedures. Special attention is given to the operative techniques and postoperative imaging appearances of primary SLL repair with DIC ligament transfer and modified Brunelli reconstruction. ©RSNA, 2021.

Adaptive proximal scaphoid implant (APSI): a systematic review of the literature.

Scapholunate advanced collapse collapse (SLAC) is a challenging topic for hand surgeons. The adaptative proximal scaphoid implant (APSI) (Bioprofile-Tornier) is a pyrocarbon ovoid shaped interpositional implant, that allows adaptive mobility during motion. The aim of this systematic review is to analyze the clinical and radiological outcomes of APSI implants and possible complications. We performed a literature search combining the following key-words: "APSI", "Scaphoid's proximal pole", "implant", "scaphoid avascular necrosis", "SLAC", "SNAC", "pyrocarbon", "prosthesis", and "spacer" with no limitations for year of publication. We selected seven studies considered relevant to our systematic review. All studies described an improvement in the grip strength and the flexion extension arch compared to pre-operative values. The percentage of patients who reported progression of osteoarthritis (OA) with APSI was 17.3%, and implant's mobilization has a rate 5.1% (8/156). In conclusion the APSI implant is a reliable alternative for the treatment of SNAC wrist and SLAC wrist.

Trapeziectomy for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term

BackgroundSymptomatic osteoarthritis of the basal joint of the thumb (trapeziometacarpal joint) is a common disabling condition mainly affecting women. It is frequently treated with complete removal of the trapezium with or without soft-tissue interposition. There is limited evidence about whether removal of the trapezium affects stability of the wrist joint and increases the risk of developing wrist osteoarthritis. The aim of this study was to evaluate the long-term prevalence of OA in wrists with previous trapeziectomy compared to wrists with intact trapezium.MethodsPatients treated with surgery for trapeziometacarpal osteoarthritis at one orthopedic department were invited 10–29 (mean 17) years postoperatively for bilateral radiographic examination. We included radiographs from 114 hands with trapeziectomy and 46 hands with intact trapezium; 38 patients had unilateral trapeziectomy and intact contralateral trapezium. The radiographs were blinded so that the intact trapezium or the trapezial space after trapeziectomy was not visible. The radiographs were then evaluated for radiocarpal/midcarpal osteoarthritis independently by two assessors using three different osteoarthritis grading systems, including the Kellgren–Lawrence classification. The patients rated their satisfaction with the function of each of their hands on a visual analog scale (VAS) from 0 to 100 (higher score better).ResultsThe prevalence of osteoarthritis ranged from 20 to 26%, mostly mild (Kellgren–Lawrence grade 1). The prevalence of osteoarthritis did not differ between wrists with previous trapeziectomy and those with intact trapezium, both in the whole cohort and in the subgroup of patients with unilateral trapeziectomy and intact contralateral trapezium. There was no significant difference in hand function VAS scores between hands with previous trapeziectomy and hands with intact trapezium in the whole cohort or in the subgroup.ConclusionsRemoval of the trapezium as treatment for basal thumb osteoarthritis does not increase the risk of developing wrist osteoarthritis in the long term.