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Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
C Mathoulin
Surgical intervention
1 year ago
159 views
2 likes
0 comments
17:40
Arthroscopic interposition in scapholunate advanced collapse wrist arthritis, stage 2 (SLAC 2)
Scapholunate advanced collapse (SLAC) is a form of degenerative arthritis of the wrist which is commonly a sequela of scapholunate instability. SLAC follows a typical pattern which begins with arthritis of the radial styloid (stage 1). Stage 2 is marked by the involvement of the entire scaphoid fossa and the scaphoid while arthritic changes involve the midcarpal joint in stage 3. Stage 2 SLAC is typically managed with proximal row carpectomy (PRC), which preserves some degree of wrist flexion-extension arc and reduces pain. However, major drawbacks of this procedure are as follows: incongruence between lunate fossa and capitate, subsequent arthritic changes, and reduced grip strength originating from reduced carpal height. This video shows a recently described salvage procedure, namely arthroscopic interposition tendon arthroplasty (AITA), which attempts to preserve wrist motion and carpal height simultaneously restoring radiocarpal joint space and reducing pain, by interpositioning tendon graft in the radiocarpal joint.
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
C Mathoulin
Surgical intervention
6 years ago
473 views
6 likes
0 comments
06:26
Arthroscopic interposition in SLAC 2 wrist arthritis
Scapholunate dissociation is the most common carpal instability. Scapholunate instability is associated with increased scaphoid flexion and pronation with associated lunate extension. The abnormal kinematics leads to a decrease in surface area contact at the radioscaphoid joint. This abnormal articulation causes an increased concentration of load, leading to the development of degenerative arthritis. In late chronic scapholunate ligament dissociation, when the arthritis appeared (SLAC 2-SLAC 3), treatment often involves heavy palliative techniques such as resection of the first row or four bones fusion. We propose a simpler technique of arthroscopic interposition of a palmaris longus tendon, combined with a wide styloidectomy of scaphoid fossea of distal radius and a dorsal capsuloligamentous repair to stabilize the scapholunate dissociation.
Arthroscopic resection of dorsal wrist ganglia
The origin and the physiopathology of wrist ganglia are still debated. We know for sure that most of them have a common origin on the dorsal aspect of the wrist capsule in correspondence to the scapholunate ligament. The most common explanation is that there is a valve mechanism at the base of the ganglion, which controls the variable volume of these ganglions.
Therefore, the ganglion can be healed by resecting this valve mechanism at the capsular level. Resecting greater parts of the dorsal wrist capsule can often lead to joint stiffness and secondary weakness of the dorsal capsule.
Therefore, the arthroscopic resection of the ganglion stalk will heal the ganglion using a minimally invasive technique and hence avoiding the disadvantages of open surgery.
Technically speaking, a diagnostic wrist arthroscopy is performed through the ulnocarpal portals. This allows to eliminate any co-existing pathology. It also allows to see whether the stalk of the ganglion is in an ulnocarpal or a radiocarpal position.
A shaver is then introduced through the ganglion itself into the stalk, and intensive shaving is performed at the dorsal capsule in correspondence to the origin of the ganglion. Complete resection can thereby be achieved. Special postoperative care or splinting is not necessary. Mobilization can be started immediately.
M Haerle
Surgical intervention
8 years ago
1084 views
14 likes
0 comments
05:22
Arthroscopic resection of dorsal wrist ganglia
The origin and the physiopathology of wrist ganglia are still debated. We know for sure that most of them have a common origin on the dorsal aspect of the wrist capsule in correspondence to the scapholunate ligament. The most common explanation is that there is a valve mechanism at the base of the ganglion, which controls the variable volume of these ganglions.
Therefore, the ganglion can be healed by resecting this valve mechanism at the capsular level. Resecting greater parts of the dorsal wrist capsule can often lead to joint stiffness and secondary weakness of the dorsal capsule.
Therefore, the arthroscopic resection of the ganglion stalk will heal the ganglion using a minimally invasive technique and hence avoiding the disadvantages of open surgery.
Technically speaking, a diagnostic wrist arthroscopy is performed through the ulnocarpal portals. This allows to eliminate any co-existing pathology. It also allows to see whether the stalk of the ganglion is in an ulnocarpal or a radiocarpal position.
A shaver is then introduced through the ganglion itself into the stalk, and intensive shaving is performed at the dorsal capsule in correspondence to the origin of the ganglion. Complete resection can thereby be achieved. Special postoperative care or splinting is not necessary. Mobilization can be started immediately.
Wrist arthroscopy: e-learning
Performing wrist arthroscopy requires a good knowledge of anatomy, arthroscopic equipment and patient positioning.
E-learning has been developed to teach this basic knowledge to residents in orthopedic or plastic surgery who wish to perform wrist arthroscopies.
The subjects of this module are proper positioning of the patient, names and use of arthroscopic instruments, relevant anatomy, creation of portals and a description of the diagnostic inspection of the wrist.
After having assimilated the facts of this e-learning lecture, a resident should be able to perform his or her first arthroscopy in a cadaver or a wrist arthroscopy simulator.

To better visualize the expert's powerpoint presentation, please click here.
M Obdeijn
Lecture
7 years ago
751 views
2 likes
0 comments
20:28
Wrist arthroscopy: e-learning
Performing wrist arthroscopy requires a good knowledge of anatomy, arthroscopic equipment and patient positioning.
E-learning has been developed to teach this basic knowledge to residents in orthopedic or plastic surgery who wish to perform wrist arthroscopies.
The subjects of this module are proper positioning of the patient, names and use of arthroscopic instruments, relevant anatomy, creation of portals and a description of the diagnostic inspection of the wrist.
After having assimilated the facts of this e-learning lecture, a resident should be able to perform his or her first arthroscopy in a cadaver or a wrist arthroscopy simulator.

To better visualize the expert's powerpoint presentation, please click here.
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
C Mathoulin, P Liverneaux
Surgical intervention
9 years ago
1157 views
30 likes
0 comments
21:38
Tips 'n Tricks for wrist arthroscopy: installation, portals and exploration
Wrist arthroscopy allows a thorough exploration of the radiocarpal and midcarpal joints simply by carrying out small portals. This video shows how to achieve them and what can be seen in the wrist.
The purpose of this video is to understand the principle of wrist arthroscopy and how to perform the portals in the least invasive way. We can draw tendon-bone elements on the skin in order to create anatomical landmarks. Before using the knife, using a single needle is essential to identify the exact position of portals. We always start the exploration of the wrist with the radiocarpal joint, and the 3-4 portal. To find it, there are several simple ways. Once the scope is entered in the radiocarpal joint, it is possible only by this portal to explore all the articulation from radial styloid to ulnar styloid. Instrumental 6R portal will be performed. The midcarpal joint is narrower than the radiocarpal joint. We start with the ulnar midcarpal portal, the easiest to find, then an instrumental radiocarpal portal will be used. Placing the scope in a radial midcarpal position allows to explore the scapho-trapezoid-trapezium joint distally as well as the dorsal surface of the capitate bone.
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
C Mathoulin
Surgical intervention
7 months ago
300 views
2 likes
0 comments
12:20
Arthroscopic reconstruction of the TFCC using a free tendon graft
Instability of the distal radioulnar joint (DRUJ) results from injury or laxity of the ligaments responsible for stabilizing the joint. Of note, the triangular fibrocartilage complex (TFCC) plays a crucial role in maintaining DRUJ stability. Sometimes, it may be impossible to repair the TFCC due to degenerative changes in the TFCC. In such cases, DRUJ reconstruction is possible provided that there are no arthritic changes in the DRUJ with the use of tendon graft. The aim of this procedure is to reconstruct the ligament and restore function, thus providing multidirectional stability. This procedure uses a tendon graft, preferably the Palmaris Longus (PL), which is woven through trans-osseous tunnels in the distal radius, converging at the fovea through a distal ulnar trans-osseous tunnel.
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
C Mathoulin
Surgical intervention
1 year ago
146 views
1 like
0 comments
04:24
Arthroscopic scaphotrapeziotrapezoidal (STT) joint arthroplasty
Scaphotrapeziotrapezoid (STT) joint osteoarthritis is less known than other types of wrist arthritis.
This disease accounts for only 13% of all wrist arthritis sites. Isolated lesions of this joint are rare and their therapeutic management is complex.
The only treatment proposed used to be STT arthrodesis, a technically difficult procedure which caused numerous complications.
Pseudoarthrosis is common, and STT arthrodesis has been incriminated in the occurrence of radioscaphoid osteoarthritis. Techniques of distal resection combined with interposition of biological tissues such as tendons (flexor carpi radialis) was described in the 1990s. In this video, we present arthroscopic interposition of pyrocarbon implant, a safe and convenient technique for patients, with long-lasting favorable results.
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
C Mathoulin
Surgical intervention
1 year ago
367 views
6 likes
1 comment
04:08
Triangular fibrocartilage complex (TFCC) dorsal distal repair
The triangular fibrocartilage complex (TFCC) is actually more complex than it appears to be. Arthroscopy of the wrist has helped to better understand the various insertions of this proximal and distal triangular complex and to detect these lesions. The adapted treatment of these lesions made it possible to prevent failures of the conventional arthroscopic reinsertions with the disappearance of the associated distal ulnar instabilities when only a part of the problem was treated.
The healing potential of the TFCC largely depends on its vascularization. This video shows the arthroscopic repair of a peripheral distal tear of the TFCC with the in-out technique.
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
C Mathoulin
Surgical intervention
1 year ago
157 views
3 likes
0 comments
09:08
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
C Mathoulin
Surgical intervention
1 year ago
121 views
4 likes
0 comments
06:06
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.