The results of revision carpal tunnel release following previous open versus endoscopic surgery.

This study compared the outcomes of revision open carpal tunnel release following previous open versus endoscopic release to determine whether revision surgery has different results based on the type of initial surgical treatment. Thirty revision carpal tunnel releases were performed in 13 wrists that had previous endoscopic release and in 17 wrists with prior open release. At a follow-up visit an average of 30 months after surgery, self-assessment questionnaires demonstrated improved or complete symptom relief in 77% of the postendoscopic release group versus 47% in the previous open release group. Combining both groups, 18% of workers' compensation patients improved after revision surgery compared with 84% of those with conventional insurance (p < .05). Patients having persistent or recurrent symptoms following a previous endoscopic carpal tunnel release have a greater chance of symptom improvement or resolution compared with patients who had previous open carpal tunnel surgery. Our results support the observation that a higher incidence of incomplete release of the carpal tunnel is found with endoscopic surgery than with open release.

Ulna-shortening osteotomy after failed arthroscopic debridement of the triangular fibrocartilage complex.

Over a 4-year period, 160 wrist arthroscopies were performed at 1 institution. Ninety-seven patients had central or nondetached ulnar peripheral tears of the triangular fibrocartilage complex (TFCC). All these patients underwent debridement with an arthroscopic shaver. Thirteen of the 97 had persistent pain in the TFCC region for more than 3 months after surgery. At an average of 8 months after failed arthroscopic debridement of the TFCC, all 13 patients underwent a 2-mm-long ulna-shortening osteotomy with fixation by a 3.5-mm 6-hole dynamic compression plate. At follow-up examination (an average of 2.3 years later), 12 of the 13 had complete relief of pain at the ulnar side of the wrist. One patient continued to complain of pain with moderate to heavy activity use of her hand. Four of the 13 had postoperative complications: 1 had traumatic pull-out of the screws requiring reinsertion and distal radius bone graft, 1 had nonunion at 4 months after surgery that required iliac crest bone graft, and 2 had pain necessitation hardware removal. All 4 of these patients had no further problems at final follow-up evaluation. There was no statistically significant difference between the arthroscopic debridement alone cohort and the arthroscopy/ulna-shortening subgroup relative to ulnar variance or incidence of associated lunotriquetral ligament tears. On the basis of these findings the authors recommend a 2-mm-long ulna-shortening osteotomy for patients whose previous arthroscopic debridement for central or nondetached peripheral TFCC was unsuccessful in eliminating ulnar-sided wrist pain.