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The Prevalence of Pisotriquetral Arthritis in the Setting of Scapholunate Advanced Collapse
Schneider K. Rancy, BA; Samir K. Trehan, MD; Angela E. Li, MBBS; Steve K. Lee, MD; Hollis G. Potter, MD; Scott W. Wolfe, MD
Hospital for Special Surgery, New York, NY

Introduction: The purpose of this study was to determine the prevalence and severity of pisotriquetral osteoarthritis (PT OA) in patients with scapholunate advanced collapse (SLAC) as compared to a control population. We hypothesized that the prevalence and severity of PT OA would be higher among patients with SLAC wrist.
Materials and Methods: Magnetic resonance imaging (MRI) studies of 24 patients with SLAC wrist and 24 sex- and age-matched control patients were analyzed. Patients with SLAC wrist were selected from a database of wrist MRI studies performed at our institution from 2006 to 2015, excluding those with inflammatory arthritis, chondrocalcinosis, and incomplete or atraumatic scapholunate interosseous ligament rupture. Control patients, selected from the same database, underwent MRI for non-arthritic clinical indications. Clinical indications for control MRI studies included ganglion cyst (8), dorsal- and/or radial-sided wrist pain (4), FCR tendinopathy (2), soft tissue mass (2), median neuritis (2), CMC boss (1), index finger pain (1), radial sensory nerve lesion (1), tendon continuity (1), De Quervain's tenosynovitis (1), and spontaneous FPL rupture (1). Patients undergoing MRI for TCFF injury, ECU tendinopathy, or ulnar-sided wrist pain were excluded from the control cohort. MRI grading of arthritic change at the pisotriquetral joint was assessed by a musculoskeletal radiologist according to a 4-category scale: normal (grade 1), superficial wear (grade 2), high grade wear including full thickness chondral loss <25% of a joint surface (grade 3), and full thickness chondral loss affecting >25% of either joint surface (grade 4).
Results: The incidence of greatest arthritic severity (grade 4) at the pisotriquetral joint was found to be 8.3% in the control cohort, compared to 16.7% in the SLAC cohort (Table 2). This difference, however, was found to be not significant (P>0.05). Additionally, the incidence of PT OA in the control cohort was found to be 37.5% compared to 41.7% in the SLAC cohort, although binary analysis indicated that this finding did not reach significance (P>0.05) (Table 1).
Conclusion: We conclude that the incidence and severity of chondral wear at the pisotriquetral joint in SLAC wrist do not differ significantly from those found in control populations. Given reports of symptomatic PT OA developed following 4-corner arthrodesis requiring pisiform excision to alleviate pain, we recommend continued clinical vigilance for pisotriquetral dysfunction in patients with SLAC preoperatively to aid hand surgeons in identifying at-risk patients who may benefit from concurrent pisiform excision at the time of partial or total wrist arthrodesis.


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