Novel technique of arthroscopic debridement for pisotriquetral joint arthrosis through standard radiocarpal portals of wrist arthroscopy

Pisotriquetral (PT) arthrosis is one of the common cause of ulnar side wrist pain. Conservative treatment of PT arthrosis is recommended initially. Various surgical treatments have been introduced including pisiformectomy. However, there have been few reports using wrist arthroscopy for PT joint pathologies. This study aimed to introduce the novel technique of arthroscopic synovectomy, debridement, and thermal shrinkage for PT arthrosis using a standard radiocarpal wrist arthroscopic portal. We report surgical technique and clinical outcomes. The medical records of 12 patients with PT joint arthrosis treated with diagnostic wrist arthroscopy and arthroscopic debridement between December 2019 and September 2022 were retrospectively reviewed. Any intra-articular pathologies of the wrist diagnosed by wrist arthroscopy were treated simultaneously with arthroscopic synovectomy, debridement, and thermal shrinkage for PT arthrosis. Functional outcomes were evaluated by comparing quick disabilities of the arm, shoulder, and hand and visual analog scale scores for PT joint pain, measured preoperatively and at the final follow-up visit. Triangular fibrocartilage complex injuries were identified in 8 patients. Scapholunate and lunotriquetral joint instability in the midcarpal joint were observed in 2 patients. Lunate and triquetral cartilage defects were observed in 1 patient. The average follow-up period was 25 months (range: 12–41 months). At the final follow-up, the average visual analog scale score (5.3 → 0.3) and the average quick disabilities of the arm, shoulder, and hand score (36.7 → 8.5) improved significantly. Arthroscopic debridement and thermal shrinkage using standard wrist arthroscopic portals can be reliable treatment methods for patients with PT arthrosis who are unresponsive to conservative treatment before considering pisiformectomy. This treatment method is advantageous because it can lead to a more precise diagnosis of ulnar side wrist pain while simultaneously providing comprehensive treatment of accompanying injuries.