Takamasa Shimizu, MD, Shohei Omokawa, MD, Francisco del Piñal, MD, Koji Shigematsu, MD, Hisao Moritomo, MD,k Yasuhito Tanaka, MD

Journal of Hand Surgery American Edition Vol. 40, Issue 12, December 2015, Pages 2393-2400 © 2015 by the American Society for Surgery of the Hand – All rights reserved.

ABSTRACT (full text pdf. below)

Arthroscopic Partial Capitate Resection for Type Ia Avascular Necrosis: A Short-Term Outcome Analysis

Purpose To examine short-term clinical results of arthroscopic partial resection for type Ia avascular necrosis of the capitate.

Methods Patients who underwent arthroscopic treatment for type 1a avascular necrosis of the capitate with at least 1-year follow-up were identified through a retrospective chart review. The necrotic capitate head was arthroscopically resected with removal of the lunate facet and preservation of the scaphoid and hamate facets. Wrist range of motion, grip strength, and radiographic parameters—carpal height ratio, radioscaphoid angle, and radiolunate angle— were determined before surgery and at the latest follow-up. Patients completed a visual analog scale for pain; Disabilities of the Arm, Shoulder, and Hand measure; and the Patient-Rated Wrist Evaluation score before surgery and at the latest follow-up.

Results Five patients (1 male, 4 females) with a mean age of 34 years (range, 16-49 years) and a mean follow-up duration of 20 months (range, 12-36 months) were identified during the chart review. All were type Ia (Milliez classification). Arthroscopy revealed fibrillation or softening with cartilage detachment at the lunate facet of the capitate head and an intact articular surface at the scaphoid and hamate facet. At the latest follow-up, the mean wrist flexion-extension was 123º (vs 81º before surgery) and grip strength was 74% (vs 37% before surgery). The visual analog scale score for pain; the Disabilities of the Arm, Shoulder, and Hand score; and the Patient-Rated Wrist Evaluation score before surgery showed a significant improvement following treatment. Radiographic parameters did not significantly change at the final follow-up, although the proximal carpal row trended toward flexion.

Conclusions Arthroscopic partial resection of the capitate head was an acceptable treatment for type Ia avascular necrosis of the capitate. It provided adequate pain relief and improved the range of wrist motion and grip strength during short-term follow-up.

Type of study/level of evidence Therapeutic IV.

Key words: Capitate, necrosis, carpal bone, arthroscopy, partial resection.