Indications and complications

Kienbock's disease has mysterious origins. A review of the literature suggests that excessive pressure exerted by a too long radius is the most commonly accepted etiology. The shortening of the radius becomes the most conventional technique. We add to this conventional technique, by the same incision, a curettage of the necrotic bone into the lunate and its replacement by a graft vascularized by the volar carpal artery harvested from the volar aspect of the distal radius.

Arthritis of the proximal interphalangeal (PIP) joint has long presented a challenge for both surgeons and patients alike. The interplay between the joint’s soft tissue and bony anatomy is complex, as the components must work in tandem to provide an acceptable balance of both stability and motion. In the past, arthrodesis, or fusion of the joint with compression screw fixation and plating systems, was the gold standard in the treatment of arthritic joint conditions. PIP joint arthroplasty using a silicone implant is an old but safe procedure in people who do not need to use their labor force.

In this key lecture, Dr. Levadoux focuses on interposition in SLAC wrist.

In this key lecture, Dr. Compson presents the distal resection of the ulnar - ulnar impaction or ulnar-carpal abutment syndrome.

The understanding of TFCC lesions has dramatically changed in recent years. Interesting proposal from Palmer in 1981, i.e. 30 years from now, and thanks to wrist arthroscopy, we have improved our knowledge of this disco-ligamentous complex and its lesions. This presentation provides an update of what was known and our progress in the field.

In this key lecture, Dr. Luchetti outlines the arthroscopic Sauve Kapandji (SV) technique.

In this key lecture, Dr. Cohen covers the arthroscopic interposition strategy for basal joint arthritis.

In this lecture, Dr. Tse discusses the techniques used to remove a volar synovial cyst.

The arthroscopic resection of dorsal ganglia of the wrist is a safe technique which allows for a satisfactory resection of the cyst and the adjacent articular capsule. There are two different techniques for resection of the dorsal ganglia: either by passing through the radio carpal joint, or directly through the ganglion and through the midcarpal joint. This second technique will be demonstrated in this video. The patients' satisfaction rate is very high, particularly because there is neither cutaneous suture, nor immobilization of the wrist.

Three classes of TFCC peripheral 1B tears are recognized in a treatment-orientated algorithm based on arthroscopic findings. Distal tear (class 1), associated with minimal instability of the DRUJ, requires ligament to capsule suture. Complete (class 2) and proximal tears (class 3) are associated with major DRUJ instability and require foveal re-attachment of the TFCC. A new arthroscopic-assisted technique to repair the foveal attachment of the TFCC by using a suture anchor is described. It is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. The technique requires a dedicated working portal called Direct Foveal (DF) to approach the ulnar fovea. This DF portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher or a simple mosquito forceps. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and easier rehabilitation as compared to open repair.