The role of wrist arthroscopy in diagnostic work-up and pre-operative planning: A systematic analysis of 125 patients with various wrist disorders
PURPOSE: The purpose of the present study was to investigate the beneficial role of arthroscopy in the management of 125 consecutive patients with various pathologic conditions of the wrist that underwent arthroscopic investigation.
MATERIAL-METHODS: We retrospectively reviewed 125 consecutive wrist arthroscopies performed in two Orthopaedic Upper Limb Units over a ten year period (2006-2015). There were 54 male and 71 female patients with a mean age at operation of 37 years old (range 12-64 years). The preoperative diagnostic work-up included clinical examination of the wrist, X-rays and MRI scan in all patients. Patients were categorised into three distinct groups: The 94 patients (75.2%) in Group I had an established preoperative diagnosis and arthroscopy was carried out for diagnostic confirmation, further investigation or therapeutic procedures. Those in Group II (12 patients, 9.6%) had persistent unexplained pain in the presence of normal physical and/or radiological findings and arthroscopy was conducted with diagnostic intent. The remaining 19 patients (15.2%) of Group III had also an established diagnosis and underwent arthroscopy mainly for staging and preoperative planning. Therapeutic arthroscopy was considered worthwhile when the procedure could be technically performed, independently of the ultimate outcome. In Group I the arthroscopy was considered beneficial when the pre-operative diagnosis was changed, excluded or limited in such a way that the management was changed; in Group II when a diagnosis was established and in Group III when the pre-operative planning was changed. RESULTS: In Group I (n=94) arthroscopy confirmed the diagnosis in 43/94 cases (46%), and altered it in the rest; arthroscopy was beneficial in 25/43 (58.2%) patients of the group with confirmed diagnosis and in 32/51 (62.8%) of the group with altered diagnosis. In Group II (n=12) a new diagnosis related to preoperative symptoms was found in 9 cases (75%) and treated arthroscopically in 7 (78%). Finally, in Group III (n=19) arthroscopy fulfilled surgeons expectations in five patients, the procedure was of no value or inconclusive in 3 and led to modification of treatment plan to the worst in 11 (58%) cases.
CONCLUSIONS: Wrist arthroscopy has a wide range of applications, from simple irrigation and débridement to complex ligament reconstructions. Its value as a diagnostic tool is even more important when a clinical and/ or radiological diagnosis cannot be established especially in patients with chronic wrist pain. In Group II (no preoperative diagnosis) we were able to establish a diagnosis in 9/12 cases and apply arthroscopic treatment in 78%, whereas in Groups I and III (known diagnosis), the percentage of concurred diagnosis was 43/113 (42.5%), the preoperative diagnosis was altered in 57.5% and a therapeutic arthroscopy was given in 55% of the patients. In all groups the arthroscopy was beneficial in more than half of the patients (53%) showing its value in the evaluation and treatment of various wrist disorders.