Triangular fibrocartilage complex (TFCC) dorsal distal repair

Since Nakamura's outstanding works in 2000, followed by Atzei's more recent works, Triangular FibroCartilage Complex (TFCC) tears have turned out to be more complex than previously described by Palmer. In fact, the medial insertion of the TFCC is twofold: classic distal peripheral, as described by Palmer, and proximal into the distal fovea of the ulnar head with, when injured, instability of the distal radioulnar joint. This lecture reports the current comprehension of the TFCC lesion and the description of a new technique for transosseous reinsertion in case of proximal avulsion.

The origin and the physiopathology of wrist ganglia are still debated. We know for sure that most of them have a common origin on the dorsal aspect of the wrist capsule in correspondence to the scapholunate ligament. The most common explanation is that there is a valve mechanism at the base of the ganglion, which controls the variable volume of these ganglions.
Therefore, the ganglion can be healed by resecting this valve mechanism at the capsular level. Resecting greater parts of the dorsal wrist capsule can often lead to joint stiffness and secondary weakness of the dorsal capsule.
Therefore, the arthroscopic resection of the ganglion stalk will heal the ganglion using a minimally invasive technique and hence avoiding the disadvantages of open surgery.
Technically speaking, a diagnostic wrist arthroscopy is performed through the ulnocarpal portals. This allows to eliminate any co-existing pathology. It also allows to see whether the stalk of the ganglion is in an ulnocarpal or a radiocarpal position.
A shaver is then introduced through the ganglion itself into the stalk, and intensive shaving is performed at the dorsal capsule in correspondence to the origin of the ganglion. Complete resection can thereby be achieved. Special postoperative care or splinting is not necessary. Mobilization can be started immediately.

In this key lecture, Dr. Caloia focuses on the arthroscopic treatment of scaphoid non-union without bone graft.

In this key lecture, Dr. Levadoux outlines the Hammock arthroscopic tendon graft interposition in SLAC wrist stage I and II.

In this key lecture, Dr. Arianni focuses on wrist arthroscopy dorsal capsuloligamentous repair.

In this key lecture, Dr. Rizzo presents wrist arthroscopy indications and complications.

Treatment of 1st CMC arthritis is controversial. Many techniques have been described, and indications are related to the stage of osteoarthritis. When the only trapeziometacarpal joint is involved with preserved axes, we can propose to put a pyrocarbon implant arthroscopically.

Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.

In this key lecture, Dr. Yanni presents an update of arthroscopic radial styloidectomy.

Dorsal wrist Ganglia (DWG) commonly miscalled “synovial cysts” treatment is controversial. Currently, arthroscopic resection should be considered the first choice treatment for Dorsal Wrist Ganglia due to its numerous advantages, including a significant low recurrence rate, rapid return to activities and low complication rate.