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Arthroscopic Resection Arthroplasty of the Radial Column for Scapholunate Advanced Collapse Wrist
Tyson Cobb, MD1; Anna Walden, DC2; Jessica Wilt, BS3
1Director of Hand Surgery, Orthopaedic Specialists, PC, Davenport, IA; 2Clinical Research, Palmer Center for Chiropractic Research, Davenport, IA; 3Orthopaedic Specialists, Davenport, IA

Introduction: The purpose of this study was to evaluate short-term outcomes of arthroscopic resection arthroplasty of the radial column (ARARC) for scapholunate advanced collapse (SLAC) wrist and compare outcomes to literature controls of 4-corner fusion (4CF).

Materials & Methods: IRB approval and signed consents were obtained. Data were collected prospectively on 9 patients with SLAC wrist who chose to undergo ARARC in lieu of 4CF or proximal row carpectomy. The average age was 57 years (range 41 to 77), including 8 males and 1 female. Subjective and objective data were collected preoperatively and postoperatively at 1, 3, 6, 12 months and annually thereafter by an occupational hand therapist. All patients had two-year minimum follow-up. Average follow-up was 30 months (range 24-61). Data collected at each time interval included wrist ROM, grip strength, disabilities of arm, shoulder, and hand (DASH) questionnaire and numeric rating scale for pain. Patients also ranked satisfaction (0 = not satisfied, 5 = completely satisfied). A study of 4CF for SLAC wrist was selected from the literature that reported similar outcomes with comparable follow-up. An independent Student's t-test was conducted to compare results of ARARC to literature controls of 4CF.

Results: One patient failed because of persistent pain and underwent revision surgery. Mean DASH was 64 preoperatively and 68, 39, 40, 40 and 39 at 1, 3, 6, 12 and 24 months respectively. Mean satisfaction at 24 months was 4.6 (range 3.5 to 5). Pain improved from 6.6 preoperatively to 1.7, 1.5, 1.4, 1.3 and 1.3 at the aforementioned postoperative intervals (Figure 1). Wrist ROM improved in all planes following ARARC, whereas ROM following 4CF only improved in radial deviation (Table 1). Change in total range of motion was significantly greater for ARARC (23 degrees) compared to 4CF (-19 degrees) (p < 0.001). There was no difference in grip strength between the two groups (p=0.602).

Conclusions: ARARC may be a viable surgical option for patients with SLAC wrist who desire a minimally invasive procedure. Pain improves rapidly following ARARC. ARARC yielded superior range of motion compared to literature controls of 4CF. Continued surveillance is warranted.




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