Arthroscopic Debridement for PT Joint Arthropathy

For the treatment of pisotriquetral (PT) joint arthropathy who does not response to conservative treatment, pisiform excision has been accepted as a general treatment of choice. But it has several complications and many patients do not want to excise their pisiform. We hypothesized that PT joint debridement and vaporization would improve symptoms in patients with PT joint arthropathy such as like arthroscopic synovectomy of the wrist.

Surgical Technique:

We made 3/4, 4/5, 6R portals for the radiocarpal joint. First inspect the radiocarpal joint through the 3/4 portal. Check the TFCC and lunate from the ulnar side, and push the arthroscope through the volar side and distal side of the prestyloid recess to check if it communicates with the PT joint. Once the orifice is localized, remove the membranous covering if the RC joint and the PT joint are not in communication, At this time, the arthroscopy is placed in the 3/4 portal and the shaver is placed in the 6R portal.

After communication is made, proceed the arthroscopy in the 6R portal and confirm the PT joint. Perform debridement of the PT joint radial and ulnar side by alternatively changing the arthroscopy and the shaver at the 4/5 portal and 6R portal. After debridement, vaporization is performed, and the PT joint is checked through the 6R portal, and the operation is completed. Post-op treatment was different depending on the accompanying injuries.

In conclusion, if there is arthropathy that does not respond to conservative treatment, arthroscopic debridement and vaporization are recommended to improve symptoms without pisiformectomy.