Experimental and clinical study of the volar portals of wrist arthroscopy

Objective To report the design and initial results of the volar portals of wrist arthroscopy.Methods The volar radial portal was located at the junction of flexor carpal radialis tendon and scaphoid tuberosity,while the volar ulnar portal was at the ulnar side of flexor carpal ulnaris tendon and0.5 cm proximal to pisiform.Twenty embalmed wrist specimens were used for anatomical measurements,and5 fresh-frozen wrist specimens for trial arthroscopy.From April 2004 to January 2008,20 wrist arthroscopies in which at least one volar portal was used were performed.There were 8 males and 12 females.Their ages ranged from 21-64 years(average,35.6 years).Results There was a safe zone surrounding the portal that was free of any neurovascular structures.The structures that could be clearly visualized included the dorsal capsule,the palmar segment of the scapholunate interosseous ligament and the palmar segment of the lunotri-quetral interesseous ligament.It was easy to address the dorsal wrist lesions when the arthroscopy was placed at the volar portal and the instrument was placed through the dorsal portal.No complication was found in the clinical cases.All cases were followed up for an average of 23.4 months(range,12-37 months).At the last follow-up,the dorsal and plantar flexion motion arc of the wrist reached 134°±16°,the radial and ulnar mo-tion arc 39°±8°,and the pronation and supination motion arc 139°±18°.In terms of the pain scores,there were 2 cases in grade Ⅱ,18 in grade Ⅲ before the surgery,and at the final follow-up,the pain was signifi-cantly alleviated with 11 cases in grade Ⅰ,8 in grade Ⅱ and Ⅰ in grade Ⅲ(P＜0.01).According to Gartland and Werley rating scale,10 cases were rated as excellent,6 as good,4 as fair.The excellent and good rate was 80%.Conclusion The volar approach is safe and feasible procedure and is supplemental to the tradi-tional dorsal portals. Key words: Carpal joints;  Arthroscopy;  Anatomy,regional