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Scaphoid proximal pole destruction remains a surgical challenge owing to its high propensity for nonunion and osteonecrosis. The hemi-hamate graft has shown promising results in addressing this issue. However, long-term results of non-vascularized composite grafts remain uncertain. The purpose of this study was to investigate the feasibility of a vascularized hemi-hamate osteo-chondro-ligamentous pedicled flap for the reconstruction of the proximal pole of the scaphoid. Thirty fresh cadaveric wrists were used to harvest the hamate proximal pole on the dorsal intercarpal arch. A loss of substance of the scaphoid proximal pole was simulated and the hamate flap was transferred. In 15 wrists, a canulated screw osteosynthesis was performed to assess donor site morbidity and carpus stability on post-osteosynthesis dynamic radiographs. This study suggests that the proximal hamate can be harvested pedicled on the dorsal intercarpal arch. The pedicle (average pedicle diameter 0.9 mm, mean length 31.5 mm) allowed tension-free graft placement in all dissections, except for one. The morphology of the graft was very similar to that of the scaphoid proximal pole and the palmar capito-hamate ligament allowed scapholunate ligament reconstruction in all dissections. This is the first study that describes the use of a pedicled flap to fully reconstruct the complex osteo-chondro-ligamentous anatomy of the scaphoid proximal pole. This vascularized hemi-hamate flap could facilitate better long-term preservation of cartilage biomechanical properties compared to non-vascularized grafts. Donor site morbidity requires further investigation before recommending clinical use., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Locked metacarpophalangeal joint is an uncommon phenomenon with many possible etiologies. Diagnosis can be difficult because of the many more common pathologies (trigger finger, sagittal band lesion, etc.) that can lead to a clinical picture that may resemble the locked metacarpophalangeal joint. Once the differential diagnoses have been eliminated, the etiology of this blockage must be determined and the surgical procedure must be oriented. The origin of the problem is often difficult to determine, especially since standard imaging tests are often not very informative. Several clinical forms are possible, with blockages in extension or flexion, but which will have a disabling functional impact on the overall function of the hand. Currently, there is no gold standard for the management of this condition. In this study, we performed a review of the literature in order to better understand the different possible etiologies but also to analyze the different diagnostic and therapeutic management. LEVEL OF EVIDENCE: IV., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: Fournier's gangrene is a serious pathology with a high mortality rate. Treatment requires a large debridement of necrotized tissues, conducing to a skin loss, requiring a reconstruction, which may involve different surgical techniques, depending on the context as well as the size and location of the skin loss. The most common covering technique uses split-thickness skin grafting, which however presents a risk of contracture., Case: Our 63 years old patient presented a Fournier's gangrene, leading to pubic and circular penile skin defects after multiple debridements. We decided to practice a right superficial circumflex iliac perforator (SCIP) pedicled flap to reconstruct the penile skin sheath. The flap was rotated 180 degrees and rolled around the penis., Discussion: The inguinal pedicle flap is described for penile reconstruction, the SCIP flap for perineal reconstruction, and even bilateral SCIP flaps for performing phalloplasty, but SCIP pedicled flap is not already described for isolated penile skin sheath reconstruction. Skin loss in our patient was not extensive, permitting us to perform this surgical technique. To go further, note the possibility of carrying out this reconstruction by a super-thin SCIP flap, as a pure skin graft flap., Conclusion: The SCIP pedicled flap seems us to be a safe technique for penile skin reconstruction and a good alternative to the usual skin grafts, especially regarding the lower risk of contracture, and low donor-site morbidity., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Purpose: Although tendon lacerations are common, there is currently no consensus on choice of suture. Easy and fast sutures that impart enough strength to allow mobilization are needed. This study compared the ex vivo biomechanical strength (force required to create a 2 mm tendon gap) of a novel suture (ST-knot) with that of a conventional suture (double Kessler)., Materials and Methods: Forty fresh deep flexor tendons from porcine forelimbs were used. Both repaired tendon ends were mounted on standard traction jaws of an axial traction machine at an initial distance of 40 mm for all tendons. A high-definition camera was used to determine the force forming a 2 mm gap. Ten tendons in group 1 (ST-knot) and 10 in group 2 (double Kessler) were prepared with PDS 4.0 (single thread for Kessler, double thread for ST-knot). Tendons in groups 3 (ST-knot) and 4 (double Kessler) were repaired with PDS 1.0 using the same principle., Results: There was no significant difference in the force required to form a 2 mm tendon gap between groups 1 and 2, and this trend was identical when using a stronger thread in groups 3 and 4. The maximum force before rupture, mode of repair failure, stress and stiffness were also comparable, with no significant differences between groups 1 and 2, or between groups 3 and 4., Conclusions: The ST-knot showed comparable results to the double-Kessler knot, whichever the thread used. Because it involves fewer steps than conventional techniques and is easy to perform, the ST-knot may offer a therapeutic solution, particularly in complex trauma with multiple tendon injury., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Competing Interests: Conflicts of interest and sources of funding: none declared.

Aims: Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing. Our aim was to report the results of a prospective study of arthroscopic suture of this ligament complex in patients with midcarpal instability., Methods: This prospective single-centre study was undertaken between March 2012 and May 2022. The primary outcome was to evaluate the functional outcomes of arthroscopic palmar midcarpal suture. The study included 12 patients, eight male and four female, with a mean age of 27.5 years (19 to 42). They were reviewed at three months, six months, and one year postoperatively., Results: There was a significant improvement in flexion, extension, grip strength, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire score, and pain, in all patients. After telephone contact with all patients in March 2023, at a mean follow-up of 3.85 years (2.2 to 6.25), no patient had a persistent or recurrent clunk., Conclusion: Arthroscopic suture of the midcarpal capsuloligamentous complex represents a minimally invasive, easy, and reproducible technique for the management of patients with midcarpal instbility, with a clear improvement in function outcomes and no complications., Competing Interests: None declared., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Objective: Scapholunate instability is the most common ligament injury of the wrist. In case of predynamic instability, diagnosis can be difficult, even under arthroscopy. Scapholunate instability is not the result of an isolated injury to the scapholunate interosseous ligament. Scapholunate stability is dependent not only on the scapholunate ligament, but on a complex that is comprising intrinsic and extrinsic ligaments. The dorsal capsule-scapholunate septum (DCSS) is one of the secondary stabilizers of the scapholunate complex. The objective of the present study was to investigate the correlation between DCSS lesion and predynamic scapholunate instability., Method: A prospective multicenter study included patients who underwent wrist arthroscopy for traumatic wrist. Arthroscopic DCSS lesion stage and instability according to European Wrist Arthroscopy Society stage were assessed., Results: Twenty-seven subjects were included. We found a significant correlation between pathological DCSS and predynamic scapholunate instability and a correlation between DCSS lesion severity and instability level., Conclusion: Isolated DCSS lesion should be considered a predictive factor for predynamic instability., (Copyright © 2023 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Targeted partial arthroscopic trapeziectomy with temporary distraction is a minimally invasive treatment for trapeziometacarpal osteoarthritis. We performed a retrospective single centre study from March 2011 to May 2022 and included patients with at least 5 years of follow-up. A failure was defined as a patient requiring a second procedure. Of the 28 patients with at least 5 years of follow-up, 23 were reviewed. Five of the 23 patients underwent revision surgery with a 5-year survival rate of 78%. There was a significant improvement in pain and the Quick Disabilities of the Arm, Shoulder and Hand (Q-DASH) score. There were three postoperative complications, one with complex regional pain syndrome, and two with hyperesthesia in the distribution of the sensory branch of the radial nerve. Targeted partial arthroscopic trapeziectomy with temporary distraction is a feasible temporary solution for early stage trapeziometacarpal joint osteoarthritis. However, there remains a 20% risk of failure. Level of evidence: IV., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

In advanced scapholunate instability, a scapholunate repair by open or arthroscopic ligamentoplasty is indicated. Although the radiographic results and functional scores are more or less satisfactory for open ligamentoplasty, it is often responsible for a decrease in joint amplitude postoperatively. Arthroscopic techniques are therefore of great interest, since they respect the joint capsule, but they remain technically difficult and demanding surgeries, requiring a good deal of experience in arthroscopy and using bone tunnels that are potentially a source of complications, as well as pinning to the palmar side of the wrist, which is potentially dangerous for the palmar structures of the wrist. We present a surgical technique of scapholunate ligamentoplasty under arthroscopy, focusing only on the dorsal scapholunate complex: all-dorsal arthroscopic ligamentoplasty. The advantages of all-dorsal arthroscopic ligamentoplasty are that it requires little material, does away with palmar approaches, and focuses only on the dorsal side, simplifying surgery and avoiding the creation of bone tunnels potentially at risk of fracture or avascular necrosis., (© 2023 The Authors.)

The medial plantar flap is frequently used in heel reconstruction and has been described since 1969. We took care of a 25-year-old patient with a bilateral ballistic trauma and open fractures to the distal third of both legs. Given the seriousness of the damage to the left lower limb, a trans-tibial amputation had to be performed. Concerning the right lower limb, we decided to cover the defect with a spare part's free medial plantar flap thanks to the amputated fragment. The extremity spare tissues principle is already known and described, more particularly concerning hands, in emergency traumatic surgery and in planned surgery, mainly concerning thumb reconstruction, for example for hypoplasia or after traumatic amputation. Apart from an article on the use of foot spare part in the coverage of amputation stumps, no article has reported the use of a foot spare part in reconstructive surgery, even more in traumatic surgery. We believe that the use of an extremity spare tissues should be considered in rare cases where this is possible, in order to reduce donor-site morbidity in the context of reconstructive surgery., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: In patients with perilunate injuries (PLI) with multiple ligamentous and bony injuries involving the proximal carpal row, open reduction and internal fixation (ORIF) can be difficult and lead to poor functional outcomes. Proximal row carpectomy (PRC) is an alternative procedure that has been used for severely comminuted fractures. The aim of our study is to evaluate the long-term functional outcome (minimum 5 years) of patients that underwent an emergency PRC for PLI. Methods: We conducted a retrospective study of patients who underwent PRC at our centre between 2001 and 2016. Only patients with follow-up data of more than 5 years were included in the study. We evaluated range of motion, grip strength, Mayo Modified Wrist Score (MMWS) and Quick Disabilities of Arm, Shoulder and Hand (Quick-DASH). Radiographic analyses were performed to assess the presence of radiocarpal osteoarthritis and the space between the radius and capitate. Results: Thirteen patients were included, with an average follow-up of 78.07 months (6.5 years). The MMWS was 65 points (four excellent and good, four fair and five poor results) and the Quick-DASH score was 30 points. X-ray analysis reported only 15.3% of patients with radiocarpal arthrosis and an average radio-capitate joint space of 1.92 mm. Conclusions: The outcomes of PRC in the management of PLI are comparable to the results reported in literature for conventional ORIF. PRC is a simpler procedure that minimises the need for re-intervention. Level of Evidence: Level IV (Therapeutic).

We report the case of a 58-year-old man who sustained an open palmar dislocation of the fifth metacarpophalangeal joint of the little finger secondary to a bicycle accident with an uncommon presentation. These open dislocations have only been reported once in the literature. A palmar and dorsal approach had to be used to completely free the joint from incarcerations and allow complete reduction and repair of the damaged anatomical structures. We then discuss this particular type of dislocation, its pathophysiology and management., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Introduction: Percutaneous screw fixation has recently gained popularity as an alternative to conservative treatment to avoid prolonged immobilization. The placement of a screw in the central axis of the scaphoid has been shown to be biomechanically superior to its eccentricity. Still, it poses difficulties in performing percutaneous screw fixation via both palmar and dorsal approaches., Objective: We describe a palmar percutaneous screwing of corporal fractures of the scaphoid by a simple palmar transtrapezial approach allowing an optimal centering of the screw., Method: We selected patients operated on by the same surgeon using the palmar transtrapezial approach between January 2015 and January 2019 based on the coding used for these fractures and the operative reports. In addition, pre- and postoperative data were collected from the patient's computer and paper records and by telephone contact with the patients., Results: Thirty-three patients were included. Percutaneous screw fixation of the scaphoid was performed under locoregional anesthesia in the operating room with one arm in the supine position on the arm table. No hyper-extension of the wrist was performed. The Kirchner guidewire passed through the anterior horn of the trapezium and then into the trapezium-scaphoid joint. A screw replaced it after satisfactory centering in the axis of the scaphoid. Management took place on average within 12 days after the trauma. 75.8% were A2 fractures, according to Herbert's classification. The average operating time was 16.63minutes, and in 91% of the cases, the patient was hospitalized for one day. The variation of the scapholunate angle on the preoperative profile radiographs with the angle defined by the axis of the scaphoid screw and the lunate postoperatively was on average 2.94°. One patient presented nonunion, and four showed an undersized screw with a screw overhang requiring revision surgery., Conclusion: The transtrapezial approach to fixation of acute scaphoid fractures facilitates precise percutaneous screw placement in the central axis of the scaphoid. A study of long-term complications, including the degenerative impact on the scaphotrapezial joint, is needed to assess the safety of passage through the anterior horn of the trapezium., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The trapeziometacarpal (TMC) joint is the one of the hand joints that is most affected by osteoarthritis (OA). The objective of this study was to determine if specific morphological parameters could be related to the amount of pressure endured by the joint which is one of the factors contributing to the development of this pathology. We developed 15 individualized 3D computer aided design (CAD) models of the TMC joint, each generated from the CT scan of a different participant. For each participant, we measured several crucial morphological parameters: the width and length of the trapezium bone and dorso-volar and ulno-radial curvature, of the trapezium and the metacarpal bone. Each CAD model was converted into a finite element model, of both bones and the cartilage located in between. The joint forces applied during pinch grip and power grip tasks were then applied in order to estimate the contact pressures on joint cartilage for each model. Correlations between joint contact pressures and morphology of the trapezium and the metacarpal bone were then analysed. Important variations of TMC joint pressures were observed. For both pinch and power grip tasks, the strongest correlation with joint contact pressure was with the dorso-volar curvature of the trapezium bone. Our findings indicate that dorso-volar curvature of the trapezium bone has a significant impact on mechanical loadings on the TMC joint. This contributes to understanding the prevalence of OA in certain patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Radiocarpal fractures and dislocations are rarely described in the literature. However, the consequences at the functional level are severe, with the loss of almost half of the articular amplitude. The most widespread classification is that of Dumontier, which divides the injury into two categories according to the presence or absence of a fracture. Currently, no classification considers fracture-dislocations in a global and multi-tissue manner; therefore, no therapeutic strategy has been reported., Methods: We conducted an exhaustive bibliographic search for cohort or case report articles concerning radiocarpal fracture-dislocations published between 1990 and the present. Only descriptions of the injury were identified (noting the type of fracture, direction of displacement and carpal injuries)., Results: In all, data were collected from 14 retrospective series and 16 case reports involving 218 patients. Thirty-five and 183 cases involved anterior and posterior displacement, respectively. A fracture of the distal radius was found in 183 cases and 35 cases had a dislocation only, with no significant fracture. Among the posterior displacements, 44 isolated styloid fractures, 62 styloid and posterior marginal fractures, 29 bimarginal fractures (large anterior fragment and small posterior fragment) and 31 fractures of all the fragments described by Medoff with impaction of the central pavement were found. Anterior displacement fractures were found in 17 cases (styloid and/or anterior marginal fracture). We were able to group the different traumatic clinical forms according to a six-category classification., Discussion: A review of the literature highlighted three major components in the management of radiocarpal fracture-dislocations: the bone component, the ligament component and the associated intracarpal lesions. These three components were included in our classification and allowed us to accurately describe all types of radiocarpal fracture-dislocations published in the literature. Authors currently agree on management of the bone component but disagree on that of the ligament component. Particular attention should be paid to intracarpal lesions, which lead to poor outcomes if ignored. Based on our biographical research, we propose a management plan for these complex injuries., Level of Evidence: VI., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

A conventional arthroscopic capsuloligamentous repair is a reliable surgical solution in most patients with scapholunate instability. However, this repair does not seem to be sufficient for more advanced injuries. The aim of this study was to evaluate the functional results of a wide arthroscopic dorsal capsuloligamentous repair (WADCLR) in the management of severe scapholunate instability. This was a prospective single-centre study undertaken between March 2019 and May 2021. The primary outcome was the evaluation of the reduction of the radiological deformity and the functional outcomes after WADCLR. A secondary outcome was the evaluation of the effectiveness of this technique in patients with the most severe instability (European Wrist Arthroscopy Society (EWAS) stage 5). The patients were reviewed postoperatively at three, six, and 12 months. The study included 112 patients (70 male and 42 female). Their mean age was 31.6 years (16 to 55). A total of three patients had EWAS stage 3A injuries, 12 had stage 3B injuries, 29 had stage 3C injuries, 56 had stage 4 injuries, and 12 had stage 5 injuries. There was a significant improvement of the radiological signs in all patients with a return to normal values. There was also a significant improvement in all aspects of function except for flexion, in which the mean increase was negligible (0.18° on average). There was also a significant improvement in all criteria for patients with a stage 5 injury, except for some limitation of extension, flexion, and radial and ulnar deviation, although these showed a trend towards improvement (except for flexion). WADCLR is a minimally invasive, easy, and reproducible technique with few complications, offering a clear improvement in function and a reduction in the radiological deformity at one year postoperatively., Competing Interests: The authors declare no funding and no conflict of interest related to this work., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

In the most advanced cases of scapholunate instability with dynamic or static signs, classical arthroscopic repair seems impossible. Ligamentoplasties or open surgery procedures are technically demanding, hampered by significant operative complications and often stiffening. Therapeutic simplification is therefore necessary for the management of these complex cases of advanced scapholunate instability. We propose a minimally invasive, reliable, and easily reproducible solution that requires little equipment other than arthroscopic material., (© 2022 The Authors.)

Purpose: The Pivot Shift (PS) test is a complex clinical sign that assesses the internal rotation and anterior tibial translation, which occurs abnormally in ACL deficient-knees. Because of the high inter-observer variability, different devices have been designed to characterize this complex movement in quantitative variables. The objective of this pilot study is to validate the reproducibility of intraoperative quantitative assessment of the PS with a smartphone accelerometer., Methods: Twelve ACL-injured knees were included and compared with the contralateral uninjured side. The PS was measured by two independent observers utilizing a smartphone accelerometer and graded according to the IKDC classification. Measurements were taken preoperatively, intraoperatively and postoperatively. Intraoperative readings were taken during each stage of reconstruction or repair of meniscoligamentous lesions including meniscal lesions, ramp lesions, ACL reconstruction and lateral tenodesis. Reproducibility of the measurements were evaluated according to an intraclass correlation coefficient (ICC)., Results: The intra-observer reliability was good for the first examiner and excellent for the second examiner, with the ICC 0.89 [0.67, 0.98] p < 0,001 and ICC 0.97 [0.91, 1.0] p < 0,001 respectively. The inter-observer reliability was excellent between the two observers with the ICC 0.99 [0.97, 1.0] p < 0,001. The mean tibial acceleration measured 3.45 m.s 2 (SD = 1.71) preoperatively on the injured knees and 1.03 m.s 2 (SD = 0.36) on the healthy knees, demonstrating a significant difference following univariate analysis p < 0.001. Postoperatively, no significant difference was observed between healthy and reconstructed knees The magnitudes of tibial acceleration values were correlated with the PS IKDC grade., Conclusion: The smartphone accelerometer is a reproducible device to quantitatively assess the internal rotation and anterior tibial translation during ACL reconstruction surgery. The measurements are influenced by the different surgical steps. Other larger cohort studies are needed to evaluate the specific impact of each step of the ACL reconstruction and meniscal repair on this measurement. An external validation using other technologies are needed to validate the reliability of this device to assess the PS test., Level of Evidence: Level IV, case series, pilot study., (© 2023. The Author(s).)

Exposure of the coracoid process during arthroscopic stabilization of acute acromioclavicular disjunctions (ACDs) can be achieved either by passing an extra- articular optical portal through the subacromial space or by an intra-articular optical route through the glenohumeral joint with opening of the rotator interval. The objective of our study was to compare the impact on the functional results of these two optical routes. This was a retrospective, multicentre study that included patients operated on for an acute acromioclavicular disjunction arthroscopically. The treatment consisted of surgical stabilization under arthroscopy. The surgical indication was retained for an acromioclavicular disjunction of grade 3, 4 or 5, according to the Rockwood classification. Group 1, which consisted of 10 patients, was operated on with an extra-articular subacromial optical route, and group 2, which consisted of 12 patients, was operated on with an intra-articular optical route with opening of the rotator interval according to the habits of the surgeon. A follow-up of 3 months was performed. The functional results were evaluated for each patient using the Constant score, Quick DASH, and SSV. The delays in returning to professional and sports activities were also noted. A precise postoperative radiological analysis made it possible to analyse the quality of the radiological reduction. No significant difference between the two groups was found between the Constant score (88 vs. 90; p = 0.56), Quick DASH (7 vs. 7; p = 0.58), or SSV (88 vs. 93; p = 0.36). The times to return to work (6.8 weeks vs. 7.0 weeks; p = 0.54) and sports activities (15.6 weeks vs. 19.5 weeks; p = 0.53) were also comparable. The quality of the radiological reduction was satisfactory in the two groups and did not depend on the approach. No clinically or radiologically significant differences between the extra-articular and intra-articular optical portals in the surgical treatment of acute ACDs were found. The optical route can be chosen according to the habits of the surgeon.

Introduction: Wrist arthroscopy has become an essential method in the management of patients suffering from wrist pathologies. This technique must be mastered by residents wishing to specialize in upper limb surgery. However, no study has evaluated residents' access to wrist arthroscopy., Hypothesis: Residents have difficulty accessing wrist arthroscopy surgery during their training., Materials and Methods: We sent out an online questionnaire to all orthopedic and plastic surgery referents in France. Data were collected over a 6-month period from December 2020 to May 2021. A descriptive statistical analysis was performed., Results: Regarding the 98 responses obtained, we observed that 77.54% of residents have seen between 0 and 10 wrist arthroscopies and 35.71% have never seen a wrist arthroscopy. In addition, only 23.80% of residents have had access to training on cadavers, and 57.14% of residents were trained in private facilities., Discussion: Access to the operating room remains difficult for residents in upper limb surgery. Our results suggest that wrist arthroscopy training could be improved. New training methods could be adapted for wrist arthroscopy and to overcome the lack of access to wrist arthroscopy for residents., Level of Incidence: IV., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Basal joint osteoarthritis is a real public health problem, yet there is no consensus on its treatment. Although total trapeziectomy, as well as arthroplasty, provides long-lasting efficacy, it does not seem to be adapted to a young population with complications that are often very difficult to manage. In the era of minimally invasive surgery, there is a real interest in finding conservative therapeutic alternatives for young subjects that allow them to "pass a painful milestone" and, thus, postpone the least conservative interventions. This article details the surgical technique of an arthroscopic and conservative technique: The Targeted Partial Arthroscopic Trapeziectomy and Distraction based on two goals: targeted resection of painful arthritic lesions and distraction of the joint to restore ligament tension and hopefully regrow fibrocartilage on resected lesions., (© 2022 The Authors.)

Grade 2 scapholunate advanced collapse (SLAC 2) can be treated by proximal row carpectomy with satisfactory results. However, this method is invasive and can limit function. The senior author had proposed an arthroscopic alternative with tendon interposition between the radius and proximal carpal row (arthroscopic interposition tendon arthroplasty [AITA]). However, this arthroscopic technique is technically difficult and requires a risky palmar arthroscopic portal. We report a modification of AITA, the one-loop arthroscopic radiocarpal tendon inter-position (1L-ARTI) that is simpler and needs only dorsal arthroscopic portals. Level of Evidence: Level V (Therapeutic).

We compared arthroscopic cyst resection (ACR) of dorsal ganglia of the wrist, either associated to reconstruction of the dorsal capsuloligamentous scapholunate septum (ACR-DCSS) in 66 cases in which the ganglia were painful on exertion, or isolated ACR in 15 pain-free cases. A single-center retrospective study analyzed data for the period April 2013 to May 2021. The main aim was to compare pre- and post-operative functional results (pain at rest (on a numerical rating scale: NRS), pain under effort (NRS), range of motion (°), grip strength (kg)) and recurrence rate between the two techniques. The study hypothesis was that DCSS repair improves recurrence of dorsal ganglion cyst and functional outcome. The ACR-DCSS group showed significant improvement in extension, pronation, supination, radial inclination, ulnar inclination, grip strength, pain at rest and pain on exertion. The ACR group showed significant improvement in pronation, ulnar inclination and pain on exertion. There was a significant difference in recurrence rate, in favor of ACR-DCSS. Recovery was also significantly better for the ACR-DCSS group in terms of extension, supination and pain at rest. Arthroscopic treatment of wrist ganglion cyst is a reliable, minimally invasive and reproducible technique that produces good results in terms of pain and recovery of range of motion, with significantly lower recurrence rate in case of DCSS repair. Level of evidence: Therapeutic III., (Copyright © 2022 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

Distal interphalangeal joint arthrodesis is a frequent surgical operation performed to treat severe arthritis. Nevertheless, the angle selected when fusing the joint is arbitrarily chosen without any quantified data concerning its mechanical effects, thus preventing the optimal choice for the patient. In the current study, we realized an experiment and developed a numerical model to investigate the effect of fusion angle on the biomechanics of adjacent non-operated joints. Six participants performed a pinch grip task while arthrodesis was simulated with a metal splint. Kinematic and force data were recorded during this task and used in a biomechanical model to estimate contact pressures in adjacent joints. The biomechanical model involved combining a multibody system and a finite element method. Results showed that the angle of any distal interphalangeal joint arthrodesis influences index finger kinematics and maximal grip force in several participants. For one participant, in the arthrodesis simulation, we observed an increase of 1.9 MPa in the proximal interphalangeal joint contact pressure. Our results provide quantified information about the biomechanical consequences of this surgical operation and its potential long-term effects., (© 2022. International Federation for Medical and Biological Engineering.)

Competing Interests: Conflict of interest None declared.

Scapholunate fusion appears to be an interesting surgical solution for carpal pathologies, which are sometimes difficult to manage as Kienbock's disease or chronic scapholunate instability. Open intracarpal fusion is notorious for decreasing joint range of motion due to the fusion of several carpal bones and because of the capsulotomy sectioning important ligamentous elements in carpal biomechanics. Wrist arthroscopy has already demonstrated its effectiveness in preserving joint mobility compared with open procedures. In this work, we present a detailed procedure for performing a scaphocapitate fusion under arthroscopy by specifying the key points of this procedure in our experience., (© 2022 The Authors.)

The development of radioscapholunar osteoarthritis after a distal radius joint fracture is a challenge, especially when it is addressed to young patients who want to maintain some wrist mobility. Classically, radioscapholunar arthrodesis is performed by an open longitudinal approach of more than 10 cm on the dorsal surface, largely exposing the midcarpal level. Wrist arthroscopy has already shown its effectiveness in preserving joint mobility compared to open procedures. Performing this arthroscopic procedure minimizes the "aggression" of the joint and hypothetically provides better mobility. This article details the surgical technique for performing radioscapholunar arthrodesis arthroscopically., (© 2022 The Authors.)

Conflicts of the capitolunate, causing midcarpal pain from friction can be isolated (e.g., avascular necrosis of the proximal pole of the capitate [AVNC], palmar midcarpal instability [PMCI]) or form part of a framework of more complex osteoarthritis phenomena (e.g., scaphoid pseudarthrosis [SNAC], and lesions of the scapholunate capsuloligamentous complex [SLAC]). We group in the term "conflict" all of the causes (with intact cartilage or not) causing midcarpal pain by friction. Treatment by capitolunar arthrodesis can be effective, but inevitably stiffening. In other more specific cases (i.e., AVNC), replacement of the proximal pole of the capitate with a synthetic implant or a tendon has shown variable results. In this work, we propose a management of these conflicts with a conservative arthroscopic technique, including capitolunate tendon interposition. We describe arthroscopic midcarpal tendon interposition (AMTI) for capitolunate conflicts. This technique prevents stiffness due to arthrodesis, but good experience in wrist arthroscopy is required to perform this operation., (© 2022 The Authors.)

Purpose  There is a real need to find less invasive therapeutic options for young patients suffering from osteoarthritis of the first carpometacarpal joint. We wanted to assess the effectiveness of targeted partial arthroscopic trapeziectomy with distraction of the trapeziometacarpal (TM) joint with Kirschner wires (K-wires) in 39 thumbs impacted by TM osteoarthritis. Methods  We conducted a retrospective study in which preoperative and postoperative data on pinch strength, grip strength, and pain on a visual analogue scale were collected. Subgroup analysis was performed based on two different K-wire distraction techniques. Only patients suffering from primary osteoarthritis and younger than 70 years were included. Second, we compared the frequency of complications relative to the position of the pins. Results  We found a significant improvement in pain ( p  = 0.005) and grip strength ( p  = 0.0021) as well as an improvement in pinch strength ( p  = 0.5704). There was reduction in pain for all Badia levels, which was significant for stages 2 ( p  = 0.002) and 3 ( p  = 0.032) as well as an overall improvement in grip strength and pinch strength for all Badia levels. Conclusion  Partial trapeziectomy with K-wire distraction in young patients suffering from TM osteoarthritis is a simple technique that requires minimal equipment and yields satisfactory outcomes. Conversion to another surgical treatment is still possible if this less invasive technique is unsuccessful. Level of Evidence  This is a Level IV study., Competing Interests: Conflict of Interest None declared., (Thieme. All rights reserved.)

The purpose of this study was to determine the distribution of functional knee phenotypes in a non-osteoarthritic Asian population. The Stryker Orthopaedic Modeling and Analytics (SOMA) database was searched for CT scans of the lower limb meeting the following inclusion criteria: patient age at time of image >18 and <46 years, no signs of fractures and/or previous surgery and/or degenerative changes, Asian ethnicity. A total of 80 CT scans of 40 patients were included (24 males, 16 females). The hip-knee-ankle angle (HKA), femoral mechanical angle (FMA) and tibial mechanical angle (TMA) were measured. Based on these measurements, each limb was phenotyped according to the previously introduced functional knee phenotype concept. All angles and phenotypes of the present study were compared with previously published data of a non-osteoarthritic Caucasian population (308 legs of 160 patients, 102 males, 58 females). Asian knees had a significantly lower TMA (both genders p < 0.001) but a higher FMA (males p < 0.05, females p < 0.001) than Caucasian knees but showed no difference in the HKA. Asian knees differed significantly with regard to femoral and tibial phenotypes ( p < 0.01), but not with regard to limb phenotypes. The high variability of all coronal alignment parameters highlights the importance of a detailed analysis prior to TKA. Ethnical differences underline the need for a more individualized approach in TKA.

Controversy persists around trapeziectomy as standard of care in thumb base osteoarthritis. The difficulty of management of failure requires the utmost caution in choice of the initial technique. We here report a retrospective series of 10 revision procedures following trapeziectomy, supported by a review of literature. The main cause of revision was collapse of the thumb column resulting in arthrogenic contact of the first metacarpal with the scaphoid. At a mean 73.3 months' follow-up, 5 patients had to undergo additional surgery. Mean VAS pain score was 2.9; 5 patients were pain-free. Strength was more severely impaired than joint motion, resulting in disappointing functional results. The present outcomes are consistent with the literature, which mostly comprises heterogeneous series, making it impossible draw conclusions to guide practice. The most common option seems to be to perform a new ligament procedure, with or without tendon or pyrocarbon interposition, and was the one that provided the only good result in the present series. Other techniques (composite graft, non-autogenic interposition, scaphometacarpal prosthesis) seem promising, and deserve large-scale evaluation. Thus, the gold-standard status of trapeziectomy should be weighed against the observation of these multi-operated patients in situations of therapeutic impasse. Should indications for first-line trapeziectomy be restricted, especially in patients with a revision risk factor? LEVEL OF EVIDENCE: 4., (Copyright © 2021 SFCM. Published by Elsevier Masson SAS. All rights reserved.)