PURPOSE: Focal chondral lesions of the wrist are a frequent cause of pain and, despite their high incidence, there are no well-defined criteria for their treatment. For advanced focal chondral lesions (Outerbridge IV), treatment remains challenging. Although salvage procedures, such as arthrodesis provide reliable pain relief, joint-preserving techniques, have gained increasing interest in carefully selected patients because they may preserve wrist motion while delaying irreversible salvage surgery.
METHODS: We describe the surgical technique and the clinical and functional outcomes of a prospective case series of 17 patients with wrist osteoarthritis treated with arthroscopic interposition arthroplasty using an acellular dermal allograft.
RESULTS: The mean follow-up was 28 (12-78) months. Disabilities of the Arm, Shoulder, and Hand improved from 54.1 to 13.4 and pain (visual analog scale) from 6.8 to 2.1. Range of motion was preserved, with mean wrist flexion changed from 53° to 49° and extension from 48° to 45°. There was one case of radial sensory nerve neurapraxia with spontaneous resolution, one case of anchor removal, and one case of conversion to wrist arthrodesis.
CONCLUSIONS: Arthroscopic interposition using acellular dermal matrix may represent a promising joint-preserving option to more aggressive salvage procedures for the treatment of wrist chondral lesions, providing pain relief and functional improvement without precluding or compromising future procedures.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
Read the article: PubMed · Publisher (DOI)