Focal Carpal Chondral Lesions Concurrent with Chronic Dynamic Scapholunate Instability: Distribution and Treatment

The literature lacks guidelines on treating focal carpal chondral lesions associated with chronic dynamic scapholunate instability (CDSI + C) and provides little information on its distribution. To report on the distribution and severity of focal chondral lesions in patients with a primary diagnosis of chronic dynamic scapholunate instability and to evaluate a protocol to treat CDSI + C. We conducted a longitudinal, retrospective study on 255 consecutive arthroscopies from January 2008 to December 2020 with a primary diagnosis of CDSI. We included patients with negative wrist X-rays but positive arthroscopic findings for focal chondral lesions and followed a Debride-First-Then-Wait protocol. During arthroscopy, scapholunate tears were debrided, and focal chondral lesions were treated with chondral shaving to partial carpectomy. A Dynadesis (tendon-to-tendon transfer through the distal scaphoid) or partial fusion was performed if symptoms persisted or reoccurred. Seventy-nine wrists had 175 focal chondral lesions (grades I–IV), with one to seven lesions per wrist, across 16 different sites, most commonly the radial styloid, scaphoid body, and triquetrum. After a 7.3-year follow-up (range: 2–15 years; 43% followed ≥7 years), 54 wrists (68%) remained satisfied with arthroscopic treatment outcomes, whereas 25 wrists (32%) were treated with open surgery. Focal carpal chondral lesions can occur even in early stages of scapholunate instability. We identified CDSI + C patients who benefited from minimal intervention using the Debride-First-Then-Wait protocol. From 79 wrists treated with arthroscopic debridement and chondral shaving, 68% did not need further treatment, a Dynadesis was performed for 28% and a partial fusion for 4%.