Abstract
Background There is a paucity of information on minimal surgical intervention for the treatment
of chronic dynamic scaphoid instability (CDSI) that will achieve an acceptable mid-term
result.
Purpose We hypothesize that by following a debride-first-then-wait protocol, some patients
with CDSI can be treated with arthroscopic debridement alone and avoid a reconstructive
procedure.
Patients and Methods We performed a retrospective, longitudinal study from January 2008 to December 2018
of all patients diagnosed with CDSI and treated with arthroscopic debridement of the
scapholunate interosseous ligament. In all cases, a debride-first-then-wait protocol
was followed that included a predetermined wait period after arthroscopic debridement,
giving the patient a chance to experience possible symptom improvement. This approach
integrated the patient's perceived wellness into the decision-making process. All
wrists that remained symptomatic or experienced recurrence of symptoms were treated
with a reconstructive procedure. The wrists were divided into two groups: arthroscopic
debridement only (ADO) and reconstructive procedure (RP).
Results Seventy-nine wrists (72 patients) of 191 consecutive wrist arthroscopies met the
inclusion criteria. The ADO group consisted of 43 wrists (54%). An average of 6.3
years later (range: 2–11 years), these patients remained satisfied with the results
of the arthroscopic debridement and did not want further treatment. The RP group included
36 wrists (46%) with 91.7% of reconstructive surgeries occurring within 6 months of
the arthroscopy. With a mid-term follow-up, 75% of Geissler grade II ligament tears,
48% of grade III tears, and 39% of grade IV tears were successfully treated with arthroscopic
debridement alone and avoided a reconstructive surgery.
Conclusion By adopting a debride-first-then-wait protocol, some patients with CDSI can be treated
with a more limited intervention, arthroscopic debridement. In this series, 54% of
wrists with CDSI avoided a reconstructive surgery for an average of 6.3 years.
Type of Study / Level of Evidence Case Series, Level IV.
Keywords
carpal instability - Dynadesis - dynamic scaphoid instability - scapholunate - SLIL
- wrist arthroscopy - treatment
