The inside-out progressive arthroscopic wrist arthrolysis for post-traumatic stiffness of the radiocarpal and midcarpal joints.

BACKGROUND: Wrist stiffness commonly occurs after surgery or trauma and may result from intra-articular, capsular, or extra-articular factors. When conservative treatment fails, arthroscopic arthrolysis can be an effective option to restore range of motion and improve wrist function. The "inside-out progressive arthrolysis" technique offers a systematic, stepwise approach that can be applied to both the radiocarpal (RC) and midcarpal (MC) joints.

METHODS: the authors retrospectively reviewed 69 patients (45 males, 24 females; mean age 43 years) who underwent arthroscopic wrist arthrolysis (AWA) for post-traumatic stiffness following distal radius fractures between July 2015 and February 2024. All patients had failed prolonged rehabilitation and presented with functional limitations in wrist flexion, extension, and grip strength. The inside-out progressive arthrolysis technique involved sequential steps in the radiocarpal and midcarpal joints: (1) resection of intra-articular fibrosis, (2) release of capsular adhesions from carpal bones, (3) capsular resection and (4) bony resection and correction of step-offs. We term the procedure based on the joint RC or MC, and then a number from 1 to 4, depending upon the extent of the surgery required. The procedure was tailored intraoperatively, with progression based on motion gained after each step.

RESULTS: At a mean follow-up of 23 months, significant improvements were observed in all outcome measures: wrist flexion increased from 28.3° to 62.5° (p < 0.001), extension 46.2° to 64.2° (p < 0.001), VAS pain scores 7.1 to 2.5 (p < 0.001), grip strength 33.3% to 52.7% of the contralateral side (p < 0.001), and PRWHE scores 62.5 to 21.0 (p < 0.001). No major complications or postoperative instability occurred.

CONCLUSIONS: Arthroscopic wrist arthrolysis using the inside-out progressive technique is a safe procedure that offers favourable results for post-traumatic wrist stiffness unresponsive to conservative management. The stepwise approach allows individualized treatment, achieves significant pain relief and functional gains, and avoids the morbidity of open surgery.