Jui-Tien Shih1, Hung-Maan Lee. 1. Department of Orthopaedic Surgery, Armed Forces Taoyuan General Hospital, Long-Tan, Taoyuan, Taiwan. jui_tien_shih@hotmail.com
Abstract
PURPOSE: This study examined whether radiofrequency electrothermal shrinkage has a role in the treatment of patients with symptomatic dynamic and predynamic scapholunate (SL) instability without advanced degenerative changes. METHODS: From January 1999 to July 2001, 19 wrists with laxity of the SL ligament, but with symptomatic instability, were treated with arthroscopic electrothermal shrinkage of the SL ligament using a monopolar radiofrequency probe. Before surgery, all patients underwent wrist arthroscopy to confirm the diagnosis and exclude arthritis. The sample included 16 men and 3 women with an average age of 23.3 years (range, 18 to 27 years). The average time from injury to operation was 17.2 months (range, 14 to 28 months). All patients underwent follow-up at our clinic regularly for an average of 28.1 months (range, 24 to 34 months). RESULTS: All 19 patients had attenuation or laxity of the continuity SL ligament in the radiocarpal joint. Modified Mayo wrist scores revealed the following functionality: the total arc of wrist motion in the flexion-extension plane loss averaged 5.1 degrees (P > .01). Grip force improved significantly, with 14.7% improvement of that on the normal side (P < .01). The Wilcoxon signed-rank test was used to compare the results: the postoperative scores were significantly better than the preoperative scores (P < .01). Fifteen patients (79%) were fully satisfied with the results and returned to their preinjury activity. Four patients (21%) had recurrent laxity of the SL joint. CONCLUSIONS: Electrothermal shrinkage of the SL ligament in patients with symptomatic, predynamic and dynamic SL instability had a 79% success rate at a minimum of 2 years' follow-up. LEVEL OF EVIDENCE: Level IV, case series.
PURPOSE: This study examined whether radiofrequency electrothermal shrinkage has a role in the treatment of patients with symptomatic dynamic and predynamic scapholunate (SL) instability without advanced degenerative changes. METHODS: From January 1999 to July 2001, 19 wrists with laxity of the SL ligament, but with symptomatic instability, were treated with arthroscopic electrothermal shrinkage of the SL ligament using a monopolar radiofrequency probe. Before surgery, all patients underwent wrist arthroscopy to confirm the diagnosis and exclude arthritis. The sample included 16 men and 3 women with an average age of 23.3 years (range, 18 to 27 years). The average time from injury to operation was 17.2 months (range, 14 to 28 months). All patients underwent follow-up at our clinic regularly for an average of 28.1 months (range, 24 to 34 months). RESULTS: All 19 patients had attenuation or laxity of the continuity SL ligament in the radiocarpal joint. Modified Mayo wrist scores revealed the following functionality: the total arc of wrist motion in the flexion-extension plane loss averaged 5.1 degrees (P > .01). Grip force improved significantly, with 14.7% improvement of that on the normal side (P < .01). The Wilcoxon signed-rank test was used to compare the results: the postoperative scores were significantly better than the preoperative scores (P < .01). Fifteen patients (79%) were fully satisfied with the results and returned to their preinjury activity. Four patients (21%) had recurrent laxity of the SL joint. CONCLUSIONS: Electrothermal shrinkage of the SL ligament in patients with symptomatic, predynamic and dynamic SL instability had a 79% success rate at a minimum of 2 years' follow-up. LEVEL OF EVIDENCE: Level IV, case series.
Authors: Spencer J. Montgomery; Natalie J. Rollick; Jeremy F. Kubik; Alexander R. Meldrum; Neil J. White Journal: Can J Surg Date: 2019-03-22 Impact factor: 2.089