Arthroscopic Reverse Wafer Resection for Ulnocarpal Impingement

I read with great interest the recent paper by Ozcelik on “Arthroscopic reverse wafer resection for ulnocarpal impingement” J Wrist Surg September 2023 (doi: https://doi.org/10.1055/s-0043-1775819. ISSN 2163-3916). The reverse wafer resection is indeed an intelligent method for treating ulnocarpal conflict when the lunate (and triquetrum) is affected by osteochondropathic damage, either in isolation or in combination with damage to the ulnar head. This procedure creates additional space in the ulnocarpal joint, allowing for freer motion of the ulnar head and preventing conflict with the lunate and triquetrum.

However, I would like to inform you that this technique is not new, as it was already described by Luchetti, Marcovici, and Cozzolino in 2022 in the chapter entitled “Arthroscopic Technique of Wafer Resection” in the ISAKOS book “Arthroscopy and Endoscopy of the Elbow, Wrist and Hand.”[1]

Furthermore, I would like to point out that we currently have several arthroscopic options for treating ulnocarpal conflict, particularly in cases of ulnar plus variance:

1. Traditional technique for cases involving damage to the TFCC articular disc: arthroscopic wafer resection of the ulnar head.

2. Reverse wafer technique (when the ulnar head and/or the TFCC ligament are intact):

   • Resection of only the proximal part of the lunate and triquetrum affected by osteochondropathy.

   • Combined resection of both the proximal part of the lunate and triquetrum at the site of osteochondropathy, along with resection of the ulnar head (indicated for ulnar plus variance and osteochondropathic damage of the lunate and triquetrum).

3. Wafer resection of the head of the ulna below the triangular ligament, performed in cases where both the lunotriquetral joint and the articular disc of the TFCC remain intact, using a direct approach to the DRUJ.

Thank you for considering this letter. I believe these clarifications may provide valuable context for understanding the evolution and technical nuances of arthroscopic wafer resection in ulnocarpal conflict.

Publikationsverlauf

Eingereicht: 04. Februar 2026

Angenommen: 10. Februar 2026

Artikel online veröffentlicht:
05. März 2026

• Reference

• 1 Luchetti R, Marcovici LL, Cozzolino R. Arthroscopic technique of wafer resection. In: Bhatia DN, Bain GI, Poehling GG, Graves BR. eds. Arthroscopy and Endoscopy of the Elbow,Wrist and Hand: Surgical Anatomy and Techniques. ISAKOS. Springer; 2022: 779-797