Wrist Arthroscopy Research Articles

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 3andFigure 3, which now show accurate incidence rates. We have also updatedFigure 6and the corresponding sections of the results accordingly. These corrections did not affect any other figures or tables, not the overall conclusions, and the text in the discussion section remains unchanged. The correct data further emphasizes the findings in our original article. We apologize for any confusion caused by these errors and appreciate the opportunity to correct the publication.

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

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. A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation. The diagnosis was confirmed as chronic DRUJ instability. The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05). TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.

Arthroscopic Suture Anchor Scapholunate Capsulodesis

Abstract Background: A retrospective review was performed of 15 adult patients who underwent arthroscopic suture anchor scapholunate capsuloligamentous repair between 2021 and 2023. Patient/Methods/Results: There were 12 male and 3 female patients, with a mean age of 44.9 years. Eight patients had European Wrist Arthroscopy Society (EWAS) II (Geissler II), four patients had EWAS IIIC (Geissler III), and three patients had EWAS IV (Geissler IV). After a follow-up of 12 months (12–26), the mean grip strength significantly improved by 131% compared with presurgery. There was a significant improvement in the visual analog scale score from 6 to 1.2, the Mayo Wrist Score from 43.5 to 86.5, and the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire score from 65.9 to 6.5. Two EWAS IV patients had recurrent symptomatic scapholunate diastasis requiring scapholunate ligamentoplasty. Conclusion: The arthroscopic dorsal scapholunate capsuloligamentous repair with suture anchors is a reliable and safe technique with minimal complications. It is recommended for reducible acute or chronic injury to the scapholunate ligament complex with suspected avulsion injury. Level Of Evidence: Level IV

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

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. Using data from the Finnish Care Register for Health Care, surgeries conducted from 2006-2007 compared with 2020-2021 were analyzed across 20 hospital districts. Selected surgeries (acromioplasty, rotator cuff repair, partial meniscectomy, wrist arthroscopy, ankle arthroscopy, and distal radius fracture fixation) were categorized based on NOMESCO procedure codes, and incidence rates in older populations were calculated based on population size derived from Statistics Finland. We found substantial regional disparities in low-value surgeries. The incidence rates were higher in hospitals with high historical incidence rates and smaller population sizes, suggesting that the uptake of evidence is slower in small non-academic hospitals. The incidence of low-value surgery is declining but regional differences remain large. It is unlikely that regional variation in disease incidence explains such large variation in low-value surgery. Instead, local treatment culture seems to be the driving force behind low-value surgery, and the practices seem to be more entrenched in small hospitals.

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. The correction of extra-articular malunion necessitates brachioradialis tenotomy, circumferential periosteum release, and intrafocal elevation with grafting to facilitate distal radius realignment following osteotomy. Computer-assisted planning with 3D-printed patient-specific instrumentation (PSI) could help execute extra-articular osteotomy with high precision. As for the management of intra-articular malunion, it may require wrist arthrotomy, arthroscopy, or PSI assistance for precise articular osteotomy and reduction of the joint surface. This review highlights the importance of early intervention, thorough preoperative planning, and appropriate surgical techniques to optimize outcomes and minimize complications. Future research should focus on large-scale randomized controlled trials to compare different surgical methods, particularly for intra-articular DRM.

Wrist and Hand Arthroscopy Procedure Volume Is Low Among Graduating Orthopaedic Surgery Residents

Wrist and Hand Arthroscopy Procedure Volume Is Low Among Graduating Orthopaedic Surgery Residents

Reliability of Wrist Arthroscopy in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Tears

Wrist arthroscopy is considered the gold standard for diagnosis of intra-articular wrist conditions including triangular fibrocartilage complex (TFCC) tears; however, the ability to reliably diagnose TFCC pathology during wrist arthroscopy is unclear. The purpose of this study was to assess the reliability of the diagnosis of TFCC tears on wrist arthroscopy videos. Five hand surgeons reviewed 43 cases on a secure web-based platform at two time points separated by 4-6 weeks. Each case included a deidentified clinical vignette and wrist radiographs with ulnar variance measurements and an arthroscopy video of ulnar wrist pathology, averaging 42 seconds. Surgeons were queried on the presence of TFCC tear and Palmer and Atzei classifications. Interobserver/intraobserver reliabilities were determined using kappa coefficients. The interobserver reliability regarding the presence/absence of TFCC tear was fair-good, with kappa coefficients of 0.596 in the first round of case review and 0.708 in the second round. The overall intraobserver reliability for the presence/absence of TFCC tear was also fair-good, with a kappa coefficient of 0.567. For cases with central TFCC tears, the interobserver reliability regarding the presence of TFCC tear was perfect, with a kappa coefficient of 1.0. When central tears were excluded, the kappa coefficients decreased to 0.322 and 0.368 in each round. The interobserver reliability for the Palmer and Atzei classifications was low, with kappa coefficients of 0.220 and 0.121 in the first round and 0.222 and 0.123 in the second round. Experienced wrist arthroscopy surgeons demonstrated fair-good interobserver reliability for the diagnosis of TFCC tear on wrist arthroscopy. However, when central TFCC tears were excluded, interobserver reliability was poor. These findings demonstrate a need for a focus on education for wrist arthroscopy anatomy. This investigation demonstrated poor agreement in surgeon identification and classification of TFCC tears, aside from central TFCC tears. The low reliability has a direct bearing on treatment considerations for TFCC tears.

Role of Vickers Ligament in the Pathogenesis of Madelung Deformity.

The Vickers ligament is thought to hinder the growth of palmar ulnar radius by tethering the lunate to the radius, leading to Madelung deformity. The purpose of this study was to clarify the nature of the Vickers ligament and investigate its pathogenesis in Madelung deformities based on our observation of the Vickers ligament. All 22 patients (33 wrists) with Madelung deformities treated surgically between 2018 and 2022 were included. The diagnosis was confirmed radiographically in all patients. The three-dimensional computed tomography (3D-CT) data of 16 patients (19 wrists) were available. Magnetic resonance imaging (MRI) data were available for 9 patients (14 wrists). Wrist arthroscopy was used in 4 patients. The Vickers ligament was resected and submitted for histopathological examination in 8 patients. Radiographic outcomes, 3D-CT, MRI, arthroscopy, surgical findings, and histopathology of the Vickers ligament were evaluated. The 3D-CT revealed that the Vickers ligament originated in the metaphysis and formed a metaphyseal defect at the palmar ulnar radius. In the sequential MR coronal images, the Vickers ligament could be divided into 3 branches, extending to the lunate, triquetrum and ulnar styloid. Arthroscopy and surgical findings revealed that the nature of the Vickers ligament was the stretched palmar ligament of the wrist. The histopathology results revealed ligamentous tissue and fibrocartilaginous metaplasia with a structure similar to that of the triangular fibrocartilage complex (TFCC). The Vickers ligament is not a separate aberrant ligament. The nature of the Vickers ligament is a combination of the stretched TFCC ligament (palmar radioulnar ligament, ulnotriquetral ligament and ulnolunate ligament) and radiolunate ligament. The possible pathogenesis of Madelung deformity might be focal early epiphyseal closure at the middle part of the sigmoid notch, which leads to focal growth retardation of the radius and pulls palmar ligaments proximally to form the Vickers ligament.

Needle Arthroscopy Versus Conventional Arthroscopy in the Evaluation of Carpal Pathology: A Comparative Study.

The needle scope is a less invasive intervention to evaluate carpal pathology. We hypothesize that there is no difference in the evaluation and diagnostic capability of the needle scope versus the conventional wrist arthroscope. Twenty patients indicated for wrist arthroscopy were prospectively enrolled. Prior to insertion of the 2.7-mm arthroscope, the needle scope evaluated for synovitis; cartilage damage (location and modified Outerbridge classification); integrity of the volar, scapholunate (SL), and lunotriquetral ligaments; and the triangular fibrocartilage complex (TFCC). Following needle scope evaluation, the surgeon completed a survey regarding the visualization and diagnosis. The 2.7-mm arthroscope was then inserted, and the surgeon completed the second portion of the survey. Statistical analysis was then completed to determine statistical significance. Twelve patients were female (60%), and the mean age was 39.8 years (±11.8 years). Eleven patients underwent arthroscopy for TFCC pathology, 4 patients for SL tearing, and 5 patients for extensive synovitis. There was no difference between the needle scope and wrist arthroscopy diagnosis. There was no difference between radiocarpal and midcarpal visualization. Surgeon-rated ease of use and diagnostic confidence were the same between two groups. The needle scope was better able to visualize the scapho-trapezium-trapezoid and carpometacarpal joints; however, the image was of marginally decreased quality. In this study, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between two groups. II (prospective cohort study)-Diagnostic.

What Have We Learned in the Wrist Joint of Distal Radius Fracture through Wrist Arthroscopy?

Abstract Background Wrist arthroscopy is an efficient tool for the surgical treatment of distal radius fracture (DRF). It could show us the various conditions of the radiocarpal joint, its effectiveness seems to overwhelm that of fluoroscopy. Methods Since July 2005, we have performed wrist arthroscopy and plate presetting arthroscopic reduction technique (PART) for 141 extra-articular and 559 intra-articular DRFs and investigated various kinds of intra-articular conditions and advantages of wrist arthroscopy. Results The pathological conditions clarified and the advantages of PART in the surgical treatment of DRF are: (1) accurate reduction of intra-articular fragments is possible compared with fluoroscopic reduction, (2) intra-articular fragments (free body) undetected with radiograph and CT can be recognized, (3) screw protrusion into joint surface can be monitored, (4) intra-articular soft tissue injury associated with fracture can be evaluated and treated, and (5) debridement of joint hematoma can be performed. Severe complications such as tendon rupture, major neurovascular injury or compartment syndrome from arthroscopy were never encountered. Conclusions The volar locking plate fixation and simultaneous arthroscopic intervention is problematic because vertical traction must be applied and released during surgery. PART can overcome these difficulties and achieved good clinical results.

Single-Portal Arthroscopy Improves the Assessment of Radial-sided Disorders of the Wrist

Abstract Purpose This study aimed to describe the technique, indications, and advantages of the single-portal arthroscopic approach for the diagnosis and staging of chronic radial-sided disorders, including scapholunate interosseous ligament (SLIL) tear, scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) deformities. Methods The single portal technique was used in 138 patients affected by suspected SLIL lesions, SLAC and SNAC wrist injuries with positive clinical symptoms and inconclusive imaging (X-ray and MRI). It was used to grade the nature of the SLIL lesion and the extension of the osteochondral damage in the SLAC and SNAC wrist deformity to guide appropriate treatment. Results Patients were divided into group 1 (SLIL: 45 cases), group 2a (SLAC: 65 cases), and group 2b (SNAC: 28 cases). In group 1, stage 4 SLIL lesions were confirmed in 36 cases and 9 were assessed as SLAC wrist deformity. In group 2a, single-portal arthroscopy confirmed the preoperative diagnosis in 74% of cases. In the remaining 26% of patients, arthroscopy modified the preoperative diagnosis: 1 case of SLAC 1 resulted in SLAC 2, 14 cases of SLAC 2 resulted in SLAC 3, 1 case of SLAC 3 resulted in SLAC 2. A case of SLAC 2 turned out to be an SLIL lesion stage 4. In group 2b, single-portal arthroscopy confirmed the preoperative diagnosis in 86% of cases. In the remaining 14% (4 cases), it modified the preoperative diagnosis: 1 of SNAC 1 resulted in SNAC 2 and the other in SNAC 3, 1 case of SNAC 2 turned out to be an SNAC 3, and 1 case of SNAC 3 resulted in SNAC 4. Conclusion Single-portal wrist arthroscopy modified the preoperative diagnosis of wrist pathology in 42 patients over 138 cases. The use of single-portal wrist arthroscopy should be considered in the evaluation of the radiocarpal and midcarpal joints to allow accurate visualization of the joint surfaces for surgeon and patient planning. Type of Study/Level of Evidence Observational study level of evidence IV.

Computer assisted surgical anatomy mapping (CASAM) of the distal Posterior Interosseous Nerve (PIN) and its relation to the wrist arthroscopy portals: A cadaver study

IntroductionThe distal Posterior Interosseous Nerve (PIN) plays an important part in the sensory innervation of the wrist joint. Introduction of the arthroscopy portals during wrist arthroscopy might injure the PIN. The anatomic variation in the trajectory of the PIN and the proximity to the dorsal arthroscopy portals have not yet been fully explored. Materials and methodsComputer assisted surgical anatomy mapping (CASAM) is a technique to digitally compute and merge photographic images using anatomic landmarks and visualize variation in anatomy. A standard wrist arthroscopy procedure was carried out on eight cadaver forearms. CASAM was used to map the trajectory of the distal PIN and measure the distance to bony landmarks and the nearest wrist arthroscopy portals. Descriptive statistics were provided for anatomical measurements. ResultsCASAM illustrated great variation in the PIN trajectories between the specimens. The mean distance from the PIN to Lister's tubercle was 9 ​mm (range 3–14, SD 3.9), the distance to the ulnar styloid was 27 ​mm (range 23–32, SD 3.3). None of the nerves showed signs of iatrogenic injury from placement of the arthroscopy portals. The 3–4 portal and the 6R portal were closest to the PIN with a respective mean distance of 9 ​mm (range 4–15, SD 3.8) and 19 ​mm (range 13–22, SD 3.2) ConclusionCASAM demonstrated the importance of understanding nerve anatomy variations and offered insight into which arthroscopy portals are most likely to damage the distal PIN. However, we conclude that the overall risk of PIN injury from wrist arthroscopy is low due to the proximity to the portals.

High Rate of Union of Scaphoid Pseudoarthrosis Treated With Arthroscopic Olecranon Bone Graft Using Antegrade Percutaneous Headless Compression Screw

To assess the healing rate of scaphoid pseudoarthrosis treated with wrist arthroscopy, olecranon bone graft, and anterograde screw fixation, as well as evaluate complications and clinical and radiologic outcomes. All patients with scaphoid nonunion were selected between January 2017 and December 2022. Inclusion criteria were patients between 18 and 60 years of age, a diagnosis of scaphoid pseudoarthrosis, complete clinical patient-reported outcomes, radiographic measurements, and at least a 1-year follow-up. Scaphoid pseudoarthrosis was treated arthroscopically with olecranon bone graft and anterograde screw fixation. Clinical assessment was performed through visual analog scale (VAS) for pain, QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, wrist range of motion using a standard goniometer, and grip strength in kilograms with a Jamar hydraulic hand dynamometer. Clinical relevance was measured with the minimal clinically important difference (MCID) for VAS and QuickDASH. Scapholunate angle was measured. Union was assessed on a computed tomography scan. Seventeen patients were included with a mean follow-up of 17.2 months. The mean age was 30.1 years, and the average time from injury to arthroscopic surgery was 11.1 months. At latest follow-up, there was an improvement in VAS pain score and QuickDASH score. Range of motion and grip strength increased at last follow-up. MCID threshold for the VAS and QuickDASH score was reached by 100% and 94.1%, respectively. Union was achieved in 16 patients (94.1%) after a median of 16 weeks (interquartile range, 16-20). Arthroscopic treatment of scaphoid pseudoarthrosis with olecranon bone graft and antegrade percutaneous headless compression screw allows a high grade of union and improves pain and function at short-term follow-up. Level IV, therapeutic case series.

In vivo non-contact regions of proximal scaphoid in six extreme wrist positions

IntroductionFractures of the scaphoid are the most common carpal injuries, account for 80-90% of all carpal fractures. 5-15% nonunion of scaphoid fractures were reported even with adequate primary treatment, which probably progresses to osteoarthritic changes several decades later. Researches regarding to scaphoid physiological characteristic in vitro and in vivo and kinds of trials in clinical practice are being kept on going, which contribute much to our clinical practice. With the advancing wrist arthroscopy, 3D-print patient-specific drill guide, and intraoperative fluoroscopic guidance, dorsal approach (mini-invasive and percutaneous technique) is being popular, through which we can implant the screw in good coincidence with biomechanics and with less disturbing tenuous blood supply of the scaphoid. Investigating the noncontact area of the dorsal proximal scaphoid in different wrist positions can facilitate preoperatively estimating insert point of the screw.Materials and methodsEight volunteers were recruited to accept CT scans in six extreme wrist positions. The images of DICOM mode were imput into the Mimics analytical system, the segmented scaphoid, lunate and radius were exported in mode of ASCII STL and were opened in the software of Geomagic studio. We created four planes based on anatomic markers on the surface of the radius and scaphoid to confine the proximal scaphoid to form the so-called non-contact regions. We measured and compared the areas in six targeted positions.ResultsAmidst six extreme wrist positions, area of the non-contact region in extreme dorsal extension (59.81 ± 26.46 mm2) was significantly the smallest, and it in extreme palmar flexion significantly was largest (170.51 ± 30.44 mm2). The non-contact regions increased in order of dorsal extension, supination, ulnar deviation, radial deviation, pronation and palmar flexion. As for two-group comparison, the non-contact region showed significantly larger (p < 0.05) in palmar flexion than the others except for in pronation individually, and in radial deviation (p < 0.05) than in dorsal extension.ConclusionsSufficient space was available for the screw started from the dorsal approach despite the wrist positions.

Arthroscopy-assisted Procedures in Hand and Wrist Surgery: An Update. Where Are We So Far?

Wrist and hand arthroscopy, despite being an old tool, has gained popularity and advanced in assisting in the treatment of various injuries and conditions in the region in recent years. Dorsal, volar, ulnar, and radial accessory portals are used to reach all points of the carpal and hand joints. The minimal tissue damage, lesser injury to the capsule and its mechanoreceptors, the assessment of injuries associated with the reason for surgery, and aesthetically more favorable scars have attracted many doctors and their patients. As a result, there has been an increase in publications and diversifications of arthroscopic techniques. The aim of this update article is to present the advances and the evidence available in the literature to assist readers in their decision on which technique to use in the treatment of wrist and hand conditions.

Evaluating effectiveness of cadaveric arthroscopic training for orthopaedic residents: A comparison of joints and training levels.

This study aimed to evaluate the effects and interactions of training level and different joints on the outcomes of cadaveric arthroscopic training courses for orthopaedic residents. This prospective study enrolled 16 orthopaedic residents who voluntarily participated in a cadaveric training programme involving the shoulder, elbow, wrist, knee and ankle joints. Outcomes were quantitatively assessed using task-specific checklists and the Arthroscopic Surgery Skill Evaluation Tool. Two-way analysis of variance (ANOVA) was conducted to determine the significance of the interactions between joint and years of training. Resident scores significantly increased after the dedicated lectures in all five joints (p = 0.003 for the shoulder module, p < 0.001 for the other joints). Two-way ANOVA revealed that the progress made after the dedicated lectures was significantly impacted by the joint (p = 0.006) and training level × joint interaction (p = 0.005) but not by the training level (p = 0.47). The simple effect of the joint was examined using Sidak's multiple comparison test. Among junior residents, the dedicated lectures resulted in more substantial progress in elbow and wrist arthroscopy when compared to shoulder arthroscopy (p = 0.020 and p = 0.043, respectively). The results suggest that, in cadaveric arthroscopic training courses for orthopaedic residents, training outcomes are primarily impacted by the specific joint being trained rather than the training level. Specifically, junior residents demonstrated greater improvement with training in procedures that are less commonly encountered during on-the-job training, such as elbow and wrist arthroscopy. These findings suggest the need to prioritise wrist and elbow arthroscopic training for junior residents to optimise educational outcomes. Level III.

Implementation of a Hand Training Curriculum in Junior Resident Education: Experience at a Military Orthopedic Residency Program

The American Society for Surgery of the Hand developed the Surgery Training and Educational Platform (STEP) in order to assess essential skills in hand surgery. The American Society for Surgery of the Hand designed modules spanning both osseous and soft tissue skills aimed to be cost effective for the purpose of orthopedic surgical education. The STEP curriculum was adapted and implemented at a single military orthopedic residency program. The following six modules were implemented: (1) depth of plunge, (2) scaphoid pinning, (3) phalangeal fracture pinning, (4) microsurgery, (5) full-thickness skin graft harvest, and (6) wrist arthroscopy. Both first- (PGY1) and second-year (PGY2) residents participated. Scores were calculated according to the original STEP curriculum criteria and were compared with historic data from the previous year. All residents responded to an evaluation questionnaire following the performance of the tasks. The PGY2 cohort outperformed PGY1 cohorts across all modules except for the depth of plunge and scaphoid fixation modules. In the phalangeal pinning module, PGY2s did significantly better when compared with pooled PGY1 performance and their own PGY1 performance (P < .05). In the microsurgery module, PGY2s scored better than pooled PGY1s. In the full-thickness skin grafting module, PGY2s outperformed PGY1s (P < .05). On the post-task evaluation, residents unanimously responded that this was a valuable exercise, but the time required to complete all the modules was significant, similar to that of the previous year survey. The STEP simulation is a cost effective and reliable program to engage residents in hand surgery-related skills. However, adaptations should be encouraged according to institutional resources to provide the most inclusive training platform possible per institutional constraints. The STEP simulation is interpreted by residents as a valuable exercise but requires a significant time commitment that could be a barrier to implementation and regular use. Therapeutic IV.

No Evidence for the Superiority of 3 Tesla Magnetic Resonance Imaging Over 1.5 Tesla Magnetic Resonance Imaging for Diagnosing Wrist Ligamentous Lesions: A Systematic Review and Meta-analysis

PurposesOur aim was to determine the diagnostic accuracy of native MRI regarding different ligamentous lesions of the wrist and to analyze the influence of technical characteristics, such as field strength, application of fat saturation, 3D sequences, and wrist coils. MethodsThe systematic search was performed using MEDLINE, Embase, and CENTRAL databases. Studies that were published before the 12th of February 2024 were included. All studies comparing the diagnostic accuracy of native wrist MRI to that of wrist arthroscopy for suspected ligamentous lesions were included. Results were analyzed by anatomic localization and technical aspects of the MRI. To assess the quality of included studies, we used the revised QUADAS-2 tool. ResultsThe systematic search revealed 5,181 articles. Thirty-seven studies, reporting 3893 ligamentous lesions, were eligible for inclusion. The studies displayed heterogeneity in terms of technical conditions, such as field strength, the use of wrist coils, the application of 3D sequences and fat saturation. Research methods also varied. Overall sensitivity and specificity were 0.78 (0.66 – 0.86) and 0.81 (0.70 – 0.89) for 1.5T MRI, while sensitivity was 0.73 (0.68 – 0.78) and specificity was 0.90 (0.59 – 0.98) for 3T MRI. There was no significant difference between the two subgroups (p=0,3807 and p=0,4248). Sensitivity was 0.82 (0.75 – 0.87) for triangular fibrocartilage complex (TFCC) lesions, 0.63 (0.50 - 0.74) for scapholunate ligament (SL) tears, and 0.41 (0.25 – 0.60) for lunotriquetral ligament (LT) lesions. Specificity for TFCC lesions was 0.82 (0.73 – 0.89), for SL tears 0.86 (0.73 - 0.93), and for LT lesions 0.93 (0.81 – 0.98). ConclusionThe sensitivity and specificity of MRI is influenced by the anatomic location of the lesion and technical conditions. In terms of diagnostic accuracy, no significant difference was found between 1.5T and 3T MRI. Level of EvidenceIII. Systematic review of Level II. - III. studies.

Enhancing wrist arthroscopy: artificial intelligence applications for bone structure recognition using machine learning

IntroductionWrist arthroscopy is a rapidly expanding surgical discipline, but has a long and challenging learning curve. One of its difficulties is distinguishing the various anatomical structures during the procedure.Although artificial intelligence has made significant progress in recent decades, its potential as a valuable tool in surgery training is largely untapped. Materials and methodsThe objective of this study was to develop an algorithm that could accurately recognize the anatomical bone structures of the wrist during arthroscopy. We prospectively included 20 wrist arthroscopies: 10 in patients and 10 in cadavers. For each surgery, we extracted and labeled images of the various carpal bones. These images were used to create a database for training, validating and testing a structure recognition algorithm. The primary criterion used was a Dice loss detection and categorization score for structures of interest, with a threshold greater than 80%. ResultsThe database contained 511 labeled images (4,088 after data augmentation). We developed a Deeplabv3+ classification algorithm with a U-Net architecture. After training and testing our algorithm, we achieved an average Dice loss score of 89% for carpal bone recognition. ConclusionThis study demonstrated reliable detection of different carpal bones during arthroscopic wrist surgery using artificial intelligence. However, some bones were detected more accurately than others, suggesting that additional algorithm training could further enhance performance. Application in real-life conditions could validate these results and potentially contribute to learning and improvement in arthroscopic wrist surgery. Level of evidenceIV.

Dorsal Radiocarpal Dislocation with Radial Styloid Fracture Treated with Arthroscopy-Assisted Reduction and Internal Fixation: A Report of Two Cases.

Radiocarpal dislocation is an uncommon injury that is usually caused by high-energy trauma. Herein, we present two cases of dorsal radiocarpal dislocation with radial styloid fractures that were treated by arthroscopy-assisted reduction and internal fixation. Wrist arthroscopy provides accurate information on intra-articular fractures and carpal and/or intracarpal ligamentous tears of the radiocarpal joint. Furthermore, the procedure enables simultaneous anatomical reduction of intra-articular fractures and radiocarpal and/or intercarpal ligament repair. Arthroscopy-assisted reduction and internal fixation yield satisfactory outcomes for patients presenting with dorsal radiocarpal dislocation and radial styloid fractures.