Wrist arthroscopy techniques

Wrist Arthroscopy Techniques 2nd Edition
Title Page
Copyright
Contents
Videos
Foreword
Preface
Acknowledgments
Contributors
1 Materials and Set-Up
	1.1 Introduction
	1.2 Materials
		1.2.1 Arthroscopy Column
		1.2.2 Arthroscope
		1.2.3 Instruments
		1.2.4 Traction
		1.2.5 Irrigation
	1.3 Set-Up
	1.4 Conclusion
	Reference
2 Surgical Approaches
	2.1 Introduction
	2.2 General Principles of Approaches
	2.3 Radiocarpal Portals
		2.3.1 3?4 Radiocarpal Portal
		2.3.2 6R Radiocarpal Portal
		2.3.3 4?5 Radiocapral Portal
		2.3.4 6U Radiocarpal Portal
		2.3.5 1?2 Radiocarpal Portal
	2.4 Midcarpal Portals
		2.4.1 Midcarpal Ulnar Portal
		2.4.2 Radial Midcarpal Portal
		2.4.3 STT Midcarpal Portal
	2.5 Distal Radioulnar Portals
		2.5.1 Distal Radioulnar Portal
		2.5.2 Direct Foveal Portal
		2.5.3 Proximal
		Distal Radioulnar?  Portal
	2.6 Trapeziometacarpal Portal
		2.6.1 Palmar 1 Portal
		2.6.2 Dorsal 1 Portal
	2.7 Palmar Portals
		2.7.1 Radial Palmar Radiocarpal Portal
		2.7.2 Ulnar Palmar Radiocarpal Portal
		2.7.3 Palmar Midcarpal Portal
	2.8 Conclusion
	Reference
3 Arthroscopic Anatomy of theWrist
	3.1 Introduction
	3.2 Principles of Exploration
	3.3 Radiocarpal Exploration
	3.4 Midcarpal Assessment
	3.5 Conclusion
4 Arthroscopic Treatment of DorsalWrist Ganglia
	4.1 Introduction
	4.2 Ligament Anatomy of the Dorsal Scapholunate Region
	4.3 Operative Technique
		4.3.1 Patient Preparation
		4.3.2 Assessment of the Size and Position of the Ganglion
		4.3.3 Exploration of the Midcarpal Joint
		4.3.4 Resection of the Dorsal Mucoid Dysplasia at the Midcarpal Interval through a Transcystic Approach
		4.3.5 Resection of the Ganglion Wall
		4.3.6 Closing and Postoperative Care
	4.4 Conclusion
	References
5 Arthroscopic DorsalWrist Ganglion Excision with Colored Dye-Aided Stalk Resection
	5.1 Introduction
	5.2 Operative Technique
		5.2.1 Patient Preparation and Positioning
		5.2.2 Surgical Steps
		5.2.3 Closure and Postoperative Care
	5.3 Conclusion
	References
6 Arthroscopic Excision of VolarWrist Ganglia
	6.1 Introduction
	6.2 Operative Technique
		6.2.1 Patient Preparation and Positioning
		6.2.2 First Surgical Phase: Intra-articular Assessment
		6.2.3 Second Surgical Phase: Identification and Resection of the Ganglion
		6.2.4 Closure and Postoperative Care
	6.3 Conclusion
7 Arthroscopic Radial Styloidectomy
	7.1 Introduction
	7.2 Operative Technique
		7.2.1 Patient Preparation
		7.2.2 Exploration of the Radiocarpal Joint
		7.2.3 Styloidectomy through the 1?2 Radiocarpal Portal
		7.2.4 Styloidectomy through the 3?4 Portal
		7.2.5 Styloidectomy through a Palmar Approach
		7.2.6 Closure and Postoperative Care
	7.3 Conclusion
	Reference
8 Anatomy of the TFCC: Current Concepts
	8.1 Introduction
	8.2 Histology
	8.3 Anatomy
	8.4 Biomechanics
	8.5 Arthroscopic Examination of TFCC Tears or Injuries
	8.6 Conclusion
	References
9 Arthroscopic Repair of Peripheral Tears of the TFCC
	9.1 Introduction
	9.2 Operative Technique
		9.2.1 Patient Preparation and Set-Up
		9.2.2 Exploration
		9.2.3 Creation of a DRUJ Portal
		9.2.4 Performing the Suture
		9.2.5 Securing the Final Suture
		9.2.6 Postoperative Care
	9.3 Conclusion
	References
10 "Double Loop? Suture Repair in Large Dorsal Tears of the TFCC
	10.1 Introduction
	10.2 Operative Technique
		10.2.1 Patient Preparation
		10.2.2 Exploration
		10.2.3 TFCC Repair
		10.2.4 Postoperative Care
	10.3 Conclusion
11 Arthroscopy-Assisted Foveal Reinsertion of the TFCC with an Anchor
	11.1 Introduction
	11.2 Operative Technique
		11.2.1 Patient Preparation
		11.2.2 Exploration
		11.2.3 Extending the Medial Incision
		11.2.4 Exploration and Debridement of the Distal Radioulnar Joint
		11.2.5 Insertion of the Anchor
		11.2.6 TFCC Suture
		11.2.7 Postoperative Care
	11.3 Conclusion
	References
12 Arthroscopic-Assisted Foveal Reinsertion of the TFCC
	12.1 Introduction
	12.2 Operative Technique
		12.2.1 Patient Preparation
		12.2.2 Exploration
		12.2.3 Arthroscopic-Assisted Foveal Refixation of the TFCC
		12.2.4 Postoperative Care
	12.3 Conclusion
13 Arthroscopic Reconstruction of the TFCC Using a Free Tendon Graft
	13.1 Introduction
	13.2 Operative Technique
		13.2.1 Patient Preparation
		13.2.2 Harvesting the Tendon Graft
		13.2.3 Making the Radial Tunnel and Passing the Tendon through
		13.2.4 Preparation of the Graft Area in the TFCC
		13.2.5 Creating the Ulnar Tunnel
		13.2.6 Passing the Graft through the Ulnar Tunnel
		13.2.7 Passage and Fixation of the Graft
		13.2.8 Closure and Postoperative Care
	13.3 Conclusion
	References
14 Arthroscopic Distal Ulnar Resection
	14.1 Introduction
	14.2 Operative Technique
		14.2.1 Patient Preparation and Positioning
		14.2.2 Exploration and Synovectomy of the Radiocarpal Joint
		14.2.3 Preparation of TFCC Ligament
		14.2.4 Distal Ulnar Resection
		14.2.5 Ulnar Head Resection when the TFCC Is Intact
		14.2.6 Closure and Postoperative Care
	14.3 Conclusion
15 Arthroscopic Hamatum Head Resection for HALT Syndrome
	15.1 Introduction
	15.2 Operative Technique
		15.2.1 Patient Preparation and Positioning
		15.2.2 Exploration of the Bones
		15.2.3 Resection of the Tip of the Hamate
		15.2.4 Closure and Postoperative Care
	15.3 Conclusion
16 Anatomy of the Scapholunate Complex
	16.1 Introduction
	16.2 Applied Anatomy and Biomechanics of the Carpal Ligaments
		16.2.1 Intrinsic Ligament: Scapholunate Interosseous Ligament
		16.2.2 Extrinsic Ligaments
	16.3 Arthroscopic Testing of Scapholunate Stability桸ew Classification System
		16.3.1 Arthroscopic Testing of Predynamic Instability
		16.3.2 EWAS Classification for Scapholunate Instability
	16.4 Arthroscopic Testing of Extrinsic Ligaments桰njury Classification
		16.4.1 Classification for Extrinsic Ligament Injury
		16.4.2 Method for Arthroscopic Testing of Extrinsic Ligaments
	16.5 Conclusion
	References
17 Dorsal Capsuloligamentous Repair of the Scapholunate Ligament Tear
	17.1 Introduction
	17.2 Operative Technique
		17.2.1 Patient Preparation and Positioning
		17.2.2 Radiocarpal Exploration
		17.2.3 Exploration of the Midcarpal Joint
		17.2.4 Performing the Dorsal Capsuloligamentous Suture
		17.2.5 Tying the First Knot
		17.2.6 K-Wire Fixation of the SL Joint (Optional)
		17.2.7 Tying the Second (Last) Knot
		17.2.8 Large SL Ligament Tear with Instability (EWAS 4)
		17.2.9 Large SL Ligament Detachment without Ligament Stump on the Scaphoid
		17.2.10 Postoperative Care
	17.3 Conclusion
	References
18 Arthroscopic-Assisted Box Reconstruction of Scapholunate Ligament with Tendon Graft
	18.1 Introduction
	18.2 Operative Techniques
		18.2.1 Patient Preparation and Positioning
		18.2.2 Exploration of Radiocarpal Joint and Midcarpal Joint
		18.2.3 Preparation of Dorsal and Volar TunnelWound
		18.2.4 Correction of the DISI Deformity and Stabilization of Scaphoid and Lunate Position
		18.2.5 Preparation of Lunate Bone Tunnel
		18.2.6 Preparation of Scaphoid Bone Tunnel
		18.2.7 Passing the PL Tendon Graft through the Scaphoid and Lunate Bone Tunnel
		18.2.8 Assessment through Midcarpal Joint Arthroscopy and Scapholunate Interval Reduction with PL Tendon Graft
	18.3 Closure and Postoperative Care
	18.4 Conclusion
	References
19 Arthroscopic-Assisted Reconstruction of LT-Ligament
	19.1 Introduction
	19.2 Operative Technique
		19.2.1 Patient Preparation and Positioning
		19.2.2 Exploration of the Ligament and the Bone
		19.2.3 Preparation of the Tendon Slip and the Bones
		19.2.4 Passing the Tendon Slip through and Securing the Graft in the Bones
	19.3 Closure and Postoperative Care
	19.4 Conclusion
	References
20 Arthroscopic-Assisted Fixation of Trans-Scaphoid Perilunate Dislocation
	20.1 Introduction
	20.2 Operative Technique
		20.2.1 Patient Preparation and Positioning
		20.2.2 Radiocarpal Arthroscopy and Synovectomy
		20.2.3 Midcarpal Arthroscopy and Exploration
		20.2.4 Dissection of the Volar Capsule
		20.2.5 Assessment of Intercarpal Ligaments Stability
		20.2.6 Screw Fixation of Scaphoid
		20.2.7 K-Wire Fixation of Lunotriquetral Joint
		20.2.8 Assessment of Stability after Fixation
		20.2.9 Closure and Postoperative Care
	20.3 Conclusion
	References
21 Volar Capsuloligamentous Suture as Treatment of Volar Midcarpal Instability
	21.1 Introduction
	21.2 Operative Technique
		21.2.1 Patient Preparation and Positioning
		21.2.2 First Phase: Arthroscopic Exploration
		21.2.3 Second Phase: Volar Ulnar Approach
		21.2.4 Third Phase: Volar CapsuleLigament Suturing
		21.2.5 Postoperative Care
	21.3 Conclusion
	References
22 Arthroscopic-Assisted Fixation of Intra-Articular Distal Radius Fractures
	22.1 Introduction
	22.2 Operative Technique (J. M. Cogent)
		22.2.1 Patient Preparation and Positioning
		22.2.2 First Surgical Phase: Provisional Fixation
		22.2.3 Second Surgical Phase: Arthroscopic Evaluation
		22.2.4 Third Surgical Phase: Final Fixation
		22.2.5 Postoperative Care
	22.3 Conclusion
	Reference
23 Arthroscopic-Guided Osteotomy for Distal Radius Malunion
	23.1 Introduction
	23.2 Indications and Contraindications
	23.3 Operative Technique
	23.4 Conclusion
	References
24 Arthroscopic-Assisted Scaphoid Fracture Fixation
	24.1 Introduction
	24.2 Operative Technique
		24.2.1 Patient Preparation and Positioning
		24.2.2 First Phase: K-Wire Insertion into the Scaphoid
		24.2.3 Second Phase: Arthroscopic Checking
		24.2.4 Third Phase: Screw Insertion
		24.2.5 Final Arthroscopic Checking
		24.2.6 Postoperative Care
	24.3 Conclusion
	Reference
25 Arthroscopic Bone Grafting for Scaphoid Nonunion
	25.1 Introduction
	25.2 Operative Technique
		25.2.1 Patient Preparation and Positioning
		25.2.2 Radiocarpal and Midcarpal Exploration
		25.2.3 Nonunion Site Preparation
		25.2.4 Bone Graft Harvesting
		25.2.5 Temporary Fixation of the Nonunion
		25.2.6 Graft Implantation and Fixation
		25.2.7 Closure and Postoperative Care
	25.3 Conclusion
26 Arthroscopic Replacement of the Proximal Pole of the Scaphoid with a Pyrocarbon Implant
	26.1 Introduction
	26.2 Operative Technique
		26.2.1 Patient Preparation and Positioning
		26.2.2 Arthroscopic Portals and Exploration
		26.2.3 Proximal Pole Excision
		26.2.4 Selection of Implant Size
		26.2.5 Placement of the Final Implant
		26.2.6 Postoperative Care
	26.3 Conclusion
	References
27 Arthroscopic Arthrolysis of theWrist
	27.1 Introduction
	27.2 Operative Technique
		27.2.1 Patient Preparation and Positioning
		27.2.2 Debridement of the Medial Radiocarpal Joint
		27.2.3 Resection of the Fibrous Radiocarpal Wall
		27.2.4 Debridement of the Radiocarpal Dorsal Recess
		27.2.5 Inspection of the Radiocarpal Joint
		27.2.6 Debridment of the Midcarpal Joint
		27.2.7 Postoperative Care
	27.3 Conclusion
28 Arthroscopic Scaphotrapeziotrapezoidal Interposition Arthroplasty
	28.1 Introduction
	28.2 Operative Technique
		28.2.1 Patient Preparation and Positioning
		28.2.2 Midcarpal Joint Debridement
		28.2.3 Scaphotrapeziotrapezoid Joint Exploration
		28.2.4 Distal Resection of the Scaphoid
		28.2.5 Implant Selection
		28.2.6 Implant Placement
		28.2.7 Closure and Postoperative Care
	28.3 Conclusion
	Reference
29 Arthroscopic Resection Arthroplasty of Thumb Carpometacarpal Joint
	29.1 Introduction
	29.2 Operative Technique
		29.2.1 Patient Preparation and Positioning
		29.2.2 Portal Placement and Exploration of the Thumb CMC Joint
		29.2.3 Debridement and Denervation of the Thumb CMC Joint
		29.2.4 Arthroscopic Resection Arthroplasty: CMC Joint
		29.2.5 Arthroscopic Resection Arthroplasty: STT Joint
		29.2.6 Tourniquet Removal, Hemostasis, and Pain Control
		29.2.7 Closure and Postoperative Care
	29.3 Conclusion
	References
30 Arthroscopic Thumb Carpometacarpal Interposition Arthroplasty
	30.1 Introduction
	30.2 Operative Technique
		30.2.1 Patient Preparation and Positioning
		30.2.2 Exploration of the Thumb Carpometacarpal Joint
		30.2.3 Debridement of the Thumb Carpometacarpal Joint
		30.2.4 Osteophyte Resection
		30.2.5 Placement of Implant
		30.2.6 Closure and Postoperative Care
	30.3 Conclusion
31 Arthroscopic Interposition Arthroplasty in Stage II Scapholunate Advanced CollapseWrists
	31.1 Introduction
	31.2 Operative Technique
		31.2.1 Patient Preparation and Positioning
		31.2.2 Harvesting the Tendon Graft
		31.2.3 Debridement and Exploration of Radiocarpal Joint
		31.2.4 Styloidectomy
		31.2.5 Stabilization of SL Joint Space
		31.2.6 Preparation for Interposition Arthroplasty
		31.2.7 Passage of the Implant抯 Dorsal Portion
		31.2.8 Passage of the Implant抯 Volar Portion
		31.2.9 Stabilization of Tendon Graft
		31.2.10 Closure and Postoperative Care
	31.3 Conclusion
32 Arthroscopic Resection Arthroplasty of the Radial Column for Scapholunate Advanced CollapseWrist
	32.1 Introduction
	32.2 Surgical Technique
		32.2.1 Patient Preparation and Positioning
		32.2.2 Arthroscopy
		32.2.3 Resection
		32.2.4 Completion
		32.2.5 Postoperative Care
	References
33 Arthroscopic PartialWrist Fusion
	33.1 Introduction
	33.2 Surgical Technique
		33.2.1 Patient Preparation and Positioning
		33.2.2 Scaphoidectomy
		33.2.3 Exploration of Radiocarpal Joint
		33.2.4 Exploration of the Midcarpal Joint
		33.2.5 Preparation for Arthrodesis
		33.2.6 Hamate Resection
		33.2.7 Addition of Bone Graft Material
		33.2.8 Fixation of the Arthrodesis
		33.2.9 Closure and Postoperative Care
	33.3 Conclusion
34 Arthroscopic Assessment of Kienbock抯 Disease
	34.1 Introduction
	34.2 Technique
		34.2.1 Set-Up
		34.2.2 Inspection
		34.2.3 Simple Procedures and Decision-Making
	34.3 Conclusion
	References
35 Arthroscopic Bone Grafting for Lunate Ganglion
	35.1 Introduction
	35.2 Operative Technique
		35.2.1 Patient Preparation and Positioning
		35.2.2 Radiocarpal Exploration
		35.2.3 Locating and Curettage of Cyst
		35.2.4 Bone Graft Harvesting
		35.2.5 Bone Graft Application
		35.2.6 Closure and Postoperative Care
	35.3 Conclusion
Index