Chapter 6 Arthroscopic Radial Styloidectomy

10.1055/b-0035-121116

Chapter 6 Arthroscopic Radial Styloidectomy

Introduction

Radial styloidectomy is frequently associated with other procedures, such as treatment of scaphoid nonunion or chronic lesions of the scapholunate ligament. It is sometimes performed alone for the treatment of isolated radial chondropathy, especially in weight lifters, or as palliative treatment in some cases of scapholunate advanced collapse (SLAC) or scaphoid nonunion advanced collapse (SNAC).

Operative Technique

Patient Preparation

The surgery is done under regional anesthesia using an arm tourniquet. The arm is fixed to the table, and Chinese traps are used to apply 5 to 7 kg of traction in the axis of the arm.

Exploration of the Radiocarpal Joint

The scope is placed through the 3–4 radiocarpal portal. After classic exploration of the radiocarpal joint, the camera is directed toward the radial part of the radiocarpal joint, following the scaphoid fossa of the radius until it reaches the radial styloid. The zone of chondropathy is identified, and one or more of three techniques are chosen according to its extent. More than one technique can be used during the same procedure.

Styloidectomy through the 1–2 Radiocarpal Portal

The scope is always stable in the 3-4 radiocarpal portal, and the camera is directed toward the radial styloid. Using a needle, the 1–2 radiocarpal portal is identified, and a shaver is installed in the joint to perform a synovectomy localized around the radial styloid.

A 3 mm bur is then used to resect the entire zone of chondropathy all the way to the subchondral tissue. The styloidectomy is 4 to 5 mm deep (i.e., slightly greater than the size of the bur). The insertions of the extrinsic ligaments—radioscaphocapitate (RSC) ligament anteriorly and dorsal radiocarpal (DRC) ligament posteriorly—must be respected ( Figs. 6.1 and 6.2a, b ).