title: The Prevalence of Pisotriquetral Arthritis in the Setting of Scapholunate Advanced Collapse.
abstract: BackgroundPrevious authors have reported pisotriquetral pain and subsequent pisiform excision following partial or total wrist fusion in patients with scapholunate advanced collapse (SLAC). Prior studies have not considered the potential role of SLAC biomechanics on pisotriquetral osteoarthritis (PT OA) development preoperatively.PurposeTo determine the prevalence and severity of PT OA in patients with SLAC as compared with a control population.Patients and MethodsMagnetic resonance imaging (MRI) studies of 24 patients with SLAC wrist and 24 sex- and age-matched control patients were analyzed. Patients with SLAC wrist were selected from a database of all wrist MRI studies performed at our institution from 2006 to 2015, excluding those with inflammatory arthritis, chondrocalcinosis, and incomplete or atraumatic scapholunate interosseous ligament rupture. Control patients underwent MRI for nonarthritic clinical indications and were chosen in an age- and sex-matched fashion. Patients undergoing MRI for triangular fibrocartilage complex injury, extensor carpi ulnaris tendinopathy, or ulnar-sided wrist pain were excluded from the control cohort. MRI grading of arthritic change at the pisotriquetral joint was assessed by a blinded musculoskeletal radiologist according to a four-category scale, with grade 4 indicating the greatest arthritic severity.ResultsThe prevalence of PT OA in the control cohort was found to be 37.5% compared with 41.7% in the SLAC cohort. The prevalence of greatest arthritic severity (grade 4) at the pisotriquetral joint was found to be 4.2% in the control cohort, compared with 16.7% in the SLAC cohort.ConclusionWe conclude that the overall prevalence of chondral wear at the pisotriquetral joint in SLAC wrist does not differ significantly from that found in control populations. We did identify a fourfold (but not statistically significant) increased prevalence of end-stage arthritis in patients with SLAC. Given reports of symptomatic PT OA developed following four-corner arthrodesis, we recommend preoperative vigilance for pisotriquetral pain in patients with SLAC arthritis.Level of EvidencePrognostic level III.
authors: Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.
authors: Schneider K
authors: SK
authors: Rancy
authors: Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.
authors: Samir K
authors: SK
authors: Trehan
authors: Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
authors: Angela E
authors: AE
authors: Li
authors: Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.
authors: Steve K
authors: SK
authors: Lee
authors: Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York.
authors: Hollis G
authors: HG
authors: Potter
authors: Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, New York.
authors: Scott W
authors: SW
authors: Wolfe
keywords: pisiform; pisotriquetral arthritis; scapholunate advanced collapse