Preventable Repeat Wrist Arthroscopies: Analysis of the Indications for 133 Cases

Abstract

Background Frequently, patients undergo repeated wrist arthroscopies for single wrist problems.

Purpose The purposes of this study were to assess the indications for repeat wrist arthroscopies and to identify potentially preventable procedures.

Methods For this retrospective, two-center study, the electronic patient records were examined for patients, who underwent repeat wrist arthroscopy in a 5-year period. The cases were sorted by the underlying pathologies and the causes that necessitated repeat arthroscopies.

Results Ulnar-sided wrist pain accounted for 100 (77%) of all 133 revision arthroscopies: 67 of which due to suspected ulnar triangular fibrocartilage complex (TFCC) avulsions, 33 due to ulnar impaction syndromes. Cartilage was reassessed in 22 (17%) wrists. Thereby, insufficient preoperative diagnostics necessitated pure diagnostic before therapeutic arthroscopy in 49 (37%) wrists: 48 of which for TFCC pathologies, one for a scapholunate (SL) ligament lesion. The uncertainty of diagnosis despite previous arthroscopy necessitated 18 (14%) revision arthroscopies: 15 for ulnar TFCC avulsions, 1 for a central TFCC lesion, 2 to reevaluate the SL ligament. Inadequate photo or video documentation of the cartilage necessitated arthroscopic reassessment in 16 (12%) wrists.

Conclusion In this series, two out of three revision arthroscopies could potentially have been prevented. Inadequate preoperative diagnostics with the lack of reliable preoperative diagnoses necessitated pure diagnostic arthroscopies for ulnar-sided wrist pain. However, even arthroscopically, the diagnosis of ulnar TFCC avulsions or SL ligament lesions is not trivial. Surgical skills and experience are necessary to detect such lesions. Finally, adequate photo or video documentation may prevent repeated arthroscopic diagnostic procedures.

Level of Evidence Level IV.

Keywords

cartilage lesions - chondromalacia - photo and video documentation - scapholunate ligament - triangular fibrocartilage complex - revision wrist arthroscopy

• References

• 1 Spahn G, Klinger HM, Baums M, Pinkepank U, Hofmann GO. Reliability in arthroscopic grading of cartilage lesions: results of a prospective blinded study for evaluation of inter-observer reliability. Arch Orthop Trauma Surg 2011; 131 (3) 377-381
• 2 Löw S, Herold D, Mühldorfer-Fodor M, Pillukat T. The effect of labeling photo documents in wrist arthroscopies on intra- and interobserver reliability. Arch Orthop Trauma Surg 2012; 132 (12) 1813-1818
• 3 Löw S, Prommersberger KJ, Pillukat T, van Schoonhoven J. Intra- and interobserver reliability of digitally photodocumented findings in wrist arthroscopy [in German]. Handchir Mikrochir Plast Chir 2010; 42 (5) 287-292
• 4 Löw S, Pillukat T, Prommersberger KJ, van Schoonhoven J. The effect of additional video documentation to photo documentation in wrist arthroscopies on intra- and interobserver reliability. Arch Orthop Trauma Surg 2013; 133 (3) 433-438
• 5 Löw S, Herold A, Eingartner C. Standard wrist arthroscopy: technique and documentation [in German]. Oper Orthop Traumatol 2014; 26 (6) 539-546
• 6 Löw S, Erne H, Schütz A, Eingartner C, Spies CK. The required minimum length of video sequences for obtaining a reliable interobserver diagnosis in wrist arthroscopies. Arch Orthop Trauma Surg 2015; 135 (12) 1771-1777
• 7 Abouali JA, Hatzantoni K, Holtby R, Veillette C, Theodoropoulos J. Revision arthroscopic Bankart repair. Arthroscopy 2013; 29 (9) 1572-1578
• 8 Cvetanovich GL, Harris JD, Erickson BJ, Bach Jr BR, Bush-Joseph CA, Nho SJ. Revision Hip Arthroscopy: A Systematic Review of Diagnoses, Operative Findings, and Outcomes. Arthroscopy 2015; 31 (7) 1382-1390
• 9 Sardana V, Philippon MJ, de Sa D , et al. Revision Hip Arthroscopy Indications and Outcomes: A Systematic Review. Arthroscopy 2015; 31 (10) 2047-2055
• 10 Shamsudin A, Lam PH, Peters K, Rubenis I, Hackett L, Murrell GA. Revision versus primary arthroscopic rotator cuff repair: a 2-year analysis of outcomes in 360 patients. Am J Sports Med 2015; 43 (3) 557-564
• 11 Shin JJ, Mascarenhas R, Patel AV , et al. Clinical outcomes following revision anterior shoulder arthroscopic capsulolabral stabilization. Arch Orthop Trauma Surg 2015; 135 (11) 1553-1559
• 12 Jang E, Danoff JR, Rajfer RA, Rosenwasser MP. Revision wrist arthroscopy after failed primary arthroscopic treatment. J Wrist Surg 2014; 3 (1) 30-36
• 13 Burns JE, Tanaka T, Ueno T, Nakamura T, Yoshioka H. Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging. Radiographics 2011; 31 (1) 63-78
• 14 Cody ME, Nakamura DT, Small KM, Yoshioka H. MR Imaging of the Triangular Fibrocartilage Complex. Magn Reson Imaging Clin N Am 2015; 23 (3) 393-403
• 15 Kirchberger MC, Unglaub F, Mühldorfer-Fodor M , et al. Update TFCC: histology and pathology, classification, examination and diagnostics. Arch Orthop Trauma Surg 2015; 135 (3) 427-437
• 16 Hahn P, Häusler A, Bruckner T, Unglaub F. Quality rating of MRI regarding TFCC lesions in the clinical practice [in German]. Handchir Mikrochir Plast Chir 2012; 44 (5) 310-313
• 17 Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review. Arthroscopy 2015; 31 (10) 2014-2020.e2
• 18 Cardenas-Montemayor E, Hartl JF, Wolf MB , et al. Subjective and objective results of arthroscopic debridement of ulnar-sided TFCC (Palmer type 1B) lesions with stable distal radio-ulnar joint. Arch Orthop Trauma Surg 2013; 133 (2) 287-293
• 19 Atzei A, Luchetti R, Braidotti F. Arthroscopic foveal repair of the triangular fibrocartilage complex. J Wrist Surg 2015; 4 (1) 22-30
• 20 Moritomo H. Open repair of the triangular fibrocartilage complex from palmar aspect. J Wrist Surg 2015; 4 (1) 2-8
• 21 Nakamura T, Matsumura N, Iwamoto T, Sato K, Toyama Y. Arthroscopy of the distal radioulnar joint. Handchir Mikrochir Plast Chir 2014; 46 (5) 295-299
• 22 Yamamoto M, Koh S, Tatebe M , et al. Arthroscopic visualisation of the distal radioulnar joint. Hand Surg 2008; 13 (3) 133-138
• 23 Pillukat T, Fuhrmann R, Windolf J, van Schoonhoven J. Arthroscopy of the distal radioulnar joint [in German]. Oper Orthop Traumatol 2014; 26 (6) 547-555
• 24 Unglaub F, Müller LP, Oppermann J, Hahn P, Spies CK. Push-off needle test for traumatic triangular fibrocartilage complex lesions. J Hand Surg Am 2014; 39 (7) 1448-1449
• 25 Iwasaki N, Nishida K, Motomiya M, Funakoshi T, Minami A. Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2- to 4-year follow-up study. Arthroscopy 2011; 27 (10) 1371-1378
• 26 Tatebe M, Horii E, Nakao E , et al. Repair of the triangular fibrocartilage complex after ulnar-shortening osteotomy: second-look arthroscopy. J Hand Surg Am 2007; 32 (4) 445-449
• 27 Palmer AK. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am 1989; 14 (4) 594-606
• 28 Mikić ZD. Age changes in the triangular fibrocartilage of the wrist joint. J Anat 1978; 126 (Pt 2): 367-384
• 29 Yamamoto M, Koh S, Tatebe M , et al. Importance of distal radioulnar joint arthroscopy for evaluating the triangular fibrocartilage complex. J Orthop Sci 2010; 15 (2) 210-215
• 30 Abe Y, Tominaga Y. Ulnar-sided wrist pain due to isolated disk tear of triangular fibrocartilage complex within the distal radioulnar joint: two case reports. Hand Surg 2011; 16 (2) 177-180
• 31 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (3) 357-365
• 32 Sammer DM, Shin AY. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. Surgical technique. J Bone Joint Surg Am 2010; 92 (Suppl 1 Pt 1): 107-113
• 33 de SA D, Cargnelli S, Catapano M , et al. Efficacy of Hip Arthroscopy for the Management of Septic Arthritis: A Systematic Review. Arthroscopy 2015; 31 (7) 1358-1370