Resultados del tratamiento de la artrosis radiocubital distal mediante el procedimiento de Sauvé Kapandji artroscópico

Abstract

Introduction: distal radioulnar osteoarthritis (ARCD) produces pain and loss of strength in pronosupination movements with functional limitation. Our objective is to present the results obtained using the Sauvé Kapandji (SK) technique in an arthroscopic way. This technique preserves the extensor retinaculum, allows for faster anatomical placement of the joint and rehabilitation. We have not found works reporting cases on this technique.

Materials and methods: we retrospectively studied seven patients with ARCD, evaluating the Dash and the Mayo score. Five male and two female using the Nakamura test. The age of the patients was 60.2 years on average. Five patients of working age and two retirees. All patients in this series were treated arthroscopically with the arthroscopic Sauvé Kapandji technique.

Results: the average follow-up was 14.7 months. Five patients had a history of wrist fracture and two had a history of Triangular Fibrocartilage Complex (CFCT) injury without instability. All seven patients had a positive Nakamura test. We obtained an average pre-operative supination of 26.4° and an average of 75° post-operatively, and a 32° pre-operative and 85° post-operative pronation. The strength obtained was 25% pre-surgical and 80% post-surgical. We obtained a pre-surgical Dash score of 88 points and a post-surgical score of 6 points. The Mayo score of the wrist was excellent in three patients, good in four. We obtained a VAS of 9.5 in the pre-surgical period and a VAS of 1 point. All patients were compliant with the incisions made.

Discussion: the SK procedure is of choice in distal radioulnar osteoarthritis and can be performed in the presence of TCCC ruptures without instability in young patients with high demand, restoring wrist mobility, stability, and grip strength. The arthroscopic technique allows the preservation of the fifth and sixth compartments, allowing an anatomical position of the ARCD, with a quick rehabilitation and a better cosmetic than conventional surgery.

Conclusion: the arthroscopic techniques of the KS procedure give results similar to the open ones in the long term, with acceptable mobility and strength, however, the arthroscopic-assisted technique allows not to open the extensor compartments, allowing a faster, acceptable functional recovery and allows to evaluate the necessary amount of articular cartilage resection and to treat associated injuries using this technique.