Wrist arthroscopy Indications and clinical applications

We reviewed retrospectively a series of 128 consecutive patients who had wrist arthroscopy at our institution between January 1988 and July 1991. The aim of the procedure was to establish a diagnosis in 27 patients, to challenge a pre-operative diagnosis in 95 patients and to evaluate joint surfaces in six patients. For the 27 patients with a previously unknown diagnosis, the diagnostic sensitivity was 67% and the specificity 100%. Arthrotomy or other intervention was avoided in 18. For the 95 patients with an established pre-operative diagnosis, arthrotomy was avoided in 45: in 26 the desired procedure could be done arthroscopically, and in 19 the diagnosis, as improved by arthroscopy, was felt not to require further treatment. Procedures performed arthroscopically included débridement of triangular fibrocartilage and inter-carpal ligament tears; lysis of adhesions, and synovectomy. In six patients, arthroscopy was performed to evaluate joint surfaces after fracture reduction or before ulnar shortening osteotomy. In none of the six was arthrotomy felt necessary after arthroscopy. Wrist arthroscopy avoided the need for further surgery in 66 (52%) of our patients; arthrotomy was avoided in 69 (54%). In cases with significant carpal instability evident pre-operatively, arthroscopy was unlikely to avoid the need for open treatment.