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A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability. This was a prospective single-centre study undertaken between March 2019 and May 2021. The primary outcome was the evaluation of the reduction of the radiological deformity and the functional outcomes after WADCLR. A secondary outcome was the evaluation of the effectiveness of this technique in patients with the most severe instability (European Wrist Arthroscopy Society (EWAS) stage 5). The patients were reviewed postoperatively at three, six, and 12 months. The study included 112 patients (70 male and 42 female). Their mean age was 31.6 years (16 to 55). A total of three patients had EWAS stage 3A injuries, 12 had stage 3B injuries, 29 had stage 3C injuries, 56 had stage 4 injuries, and 12 had stage 5 injuries. There was a significant improvement of the radiological signs in all patients with a return to normal values. There was also a significant improvement in all aspects of function except for flexion, in which the mean increase was negligible (0.18° on average). There was also a significant improvement in all criteria for patients with a stage 5 injury, except for some limitation of extension, flexion, and radial and ulnar deviation, although these showed a trend towards improvement (except for flexion). WADCLR is a minimally invasive, easy, and reproducible technique with few complications, offering a clear improvement in function and a reduction in the radiological deformity at one year postoperatively., Competing Interests: The authors declare no funding and no conflict of interest related to this work., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Scapholunate ligament tear is most frequently encountered in the aftermath of trauma in supination and extension of the wrist. It generates chronic instability, leading to osteoarthritis. It may be associated with fracture of the distal epiphysis of the radius or of the scaphoid. These lesions are often difficult to diagnose, especially in early stages. Treatment of chronic scapholunate ligament lesions before onset of osteoarthritis is a challenge for the surgeon. To date, recommendations are for open reconstruction or repair, which can improve pain and grip strength, but very often at the cost of wrist stiffness. The advent of arthroscopy has completely changed the understanding and treatment of these lesions. The present review focuses on recent contributions to the anatomy of the scapholunate complex and the anatomopathology of these dissociations, and explores classical treatments and the emerging role of arthroscopy. We shall seek to answer five questions: (1) What are the anatomical bases of the scapholunate complex, (2) What is the initial clinical and paraclinical work-up for scapholunate dissociations, and how are they to be classified, (3) What are the classical treatments for scapholunate dissociation, (4) What are the technical principles and results of arthroscopic treatment, (5) What are the limits and perspectives of arthroscopic treatment?, (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Dorsal and volar wrist ganglions are benign tumors; most of them are asymptomatic. They can disappear spontaneously. Arthroscopic resection can be performed for pain or cosmetic concern. Dorsal ganglion is more common (70%). The hypothesis of the origin is the result of mucoid dysplasia in association with intracapsular and extrasynovial ganglia that occur at the level of the dorsal scapholunate complex. Volar wrist ganglia are less common (20%) and occur mainly in the radiocarpal joint. They are due to capsular destruction at the volar insertion of the SL ligament and arise from the interval between radio scaphocapitate and long radiolunate ligament., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Lunate pseudarthrosis is a complication of lunate fractures and few cases are described in the literature. We designed a case series of lunate pseudarthrosis, to acknowledge this topic and to show our clinical experience. Methods: Four patients were included in this study. Three went through surgical treatment of lunate nonunion. Results: At 2 years' follow-up, patients had slight improvement of range of motion (ROM) and Quick-DASH score compared to preoperative measures, though two patients developed scaphocapitate, radiolunate or midcarpal osteoarthritis. The fourth patient is asymptomatic and is being followed up. Conclusions: Surgical options depend on the localization of the pseudarthrosis in the lunate. Fragment excision can be a good option when the fragment is small, preserving scapholunate (SL) stability. Caution must be taken with dorsal pole pseudarthrosis, regarding midcarpal osteoarthritis. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Introduction Large dorsal capsule tears of the wrist are misdiagnosed because this lesion is unknown. Wrist arthroscopy allowed the diagnosis and the treatment. This study reports the results of the procedure. Materials and methods This retrospective study reported the patients with dorsal capsule tears between October 2011 and September 2014. The procedure was performed on outpatient under local regional anesthesia. The diagnosis is done arthroscopically. We always found a large rupture of the dorsal capsule with direct vision of the extensor tendons from the radiocarpal joint. The reparation is performed by a dorsal capsuloligamentous repair after enlarging the 3–4 portal. Results Sixteen procedures were performed on 15 patients, which represent 2% of the wrist arthroscopy. One was excluded because the follow-up was done abroad. There were 7 men and 7 women, mean age 27,9 years old (14–43). The surgery was performed on average 21 months after the accident (2–96). The clinical examination was not specific, neither the imaging. The diagnosis was performed arthroscopically. The scapholunate ligament was intact from the radiocarpal joint in 46,6%. In the midcarpal joint, we reported 4 stage 1 with EWAS classification, 2 stage 2B, 1 stage 3A, 4 stage 3B, 1 stage 3 C and 1 stage 4. A peripheral lesion of the TFCC was reported in 6 cases. A splint was worn on average 47.8 days. The average follow-up was 7.75 months (1.5–32.5). The range of motion and strength improved in all cases. The pain decreased from 6.3 u (4–8) to 0.9 (0–2) and the dash from 44.5 (20,45–95,45) to 6.25 (0–27,27). All radiographs were normal at the longest follow-up. We reported two Südeck syndromes. Discussion Diagnosis of chronic wrist pain is difficult. More often, they are due to posttraumatic lesions - fracture or ligamentous tears, which lead both to arthrosis. A large dorsal capsule tear is one of the etiology, and its diagnosis was made possible thanks to arthroscopy, others paraclinic exams being poor. Conclusion Large dorsal capsule rupture could explain some non-diagnosed wrist pain. The diagnosis is arthroscopic. Arthroscopic suture avoids stiffness related to open surgery. These encouraging preliminary results require a larger serie with longer follow-up. [ABSTRACT FROM AUTHOR]