Arthroscopic Treatment of Interosseous Ligament Tears, Carpal Instability, and Capsular Electrothermal Shrinkage Techniques

The development of wrist arthroscopy in the mid 1980s was a

major advance in the diagnosis and management of wrist

disorders, and its application indications continue to expand

with technologic improvements. Prior to the advent of wrist

arthroscopy, the diagnosis and treatment of disorders of the

wrist was limited to radiographic studies or arthrotomy.

Arthroscopy allows for the direct visualization of articular

surfaces of the carpal bones as well as the evaluation of their

relative positions. The operative modality also allows for the

direct inspection of both extrinsic and intrinsic ligaments of the

wrist and the triangular fibrocartilage complex (TFCC). This

results in the identification of articular pathology that might

remain unrecognized with standard imaging studies. Since the

use of arthroscopic assessment of the wrist joint has gained a

prominent role as a diagnostic tool, it has become clear that

magnetic resonance imaging (MRI) and wrist arthrography are

less sensitive and specific than arthroscopy in detecting patho-

logic changes in the radiocarpal and midcarpal joints (1-3). As

a result of this increased sensitivity, the procedure allows for

the adjudication of diagnoses that had previously been gener-

ically classified as “wrist sprain” (4). For example, prior to the

advent of wrist arthroscopy, patients with either attenuation or

partial tears or attenuation of the scapholunate interosseus

ligament (SLIL) or lunotriquetral interosseus ligament (LTIL)

not visualized on MRI or arthrography were given the

diagnosis of “wrist sprain.” Wrist arthroscopy allows for the

identification of these pathologic changes and treatment in

the form of debridement and/or electrothermal collagen

shrinkage (ECS) (5).