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American Association for Hand Surgery

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Arthroscopic Resection Arthroplasty for Scapholunate Advanced Collapse Wrist
Jessica K Cobb, B.S., University of South Florida Morsani College of Medicine, Tampa, FL and Tyson K Cobb, M.D., Shoulder, Elbow, Wrist, and Hand Center of Excellence, Bettendorf, IA

Introduction: The objective of this study is to update previously published outcomes of patients undergoing arthroscopic resection arthroplasty (ARA) for scapholunate advanced collapse wrist (SLAC) while reporting on 14 additional patients.

Materials & Methods: Data were collected prospectively on 31 consecutive patients who underwent ARA for SLAC by one surgeon over 9 years, fourteen of which were included in the previous publication. Standard radiocarpal and midcarpal arthroscopy was performed using standard portals. The arthritic portion of the joint was denervated by a radiofrequency ablator (Serfas 3.5-mm, Stryker). A 4 mm barrel burr (Stryker Endoscopy, San Jose, CA) was employed to resect the styloid process, the arthritic portion of the scaphoid fossa, and the proximal 2/3rd of the scaphoid. Data were collected preoperatively and postoperatively at 1, 3, 6, and 12 months, and annually thereafter including Numeric Rating Scale for pain (0-10, 10 being worst possible pain) and postoperative satisfaction (0-5, 5 extremely satisfied). An occupational therapist measured grip, range of motion, flexion, extension, and ulnar and radial deviation which was then used to calculate total arc of motion. Disabilities of the arm, shoulder, and hand (DASH) score (0-100, 0 no disability) were recorded preoperatively and postoperatively. Pre- and postoperative data were collected in person at our private clinic. Additional phone follow-up for pain and satisfaction which was obtained in 12 patients.

Results: Mean follow-up was 63 months (range 13-158). Mean age was 62 years (range 40-78) with an equal distribution of nonmanual and manual laborers. Mean pain score was 7 (range 3-10) preoperatively and 0.2 (range 0-2) at final follow-up. Mean grip strength was 40 lbs. (range 10-80) before surgery and 50 lbs. (range 16-90) at final follow-up. Mean total arc of motion was 113 deg. (range 63-170) before surgery and 127 deg. (range 61-186) at final follow-up. Mean DASH was 42 (range 16-91) before surgery and 3 (range 0-38) at final follow up. Mean final satisfaction was 4.8 (range 4-5). There were 2 (7%) failures requiring revision surgery for persistent pain.

Conclusion: Mid-term outcomes demonstrate that ARA of SLAC wrists may be a viable surgical option for those who desire a minimally invasive procedure; however, longer follow-up and prospective studies comparing ARA of SLAC wrists to traditional surgical options are necessary.

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