Arthroscopicradiographic correlation

The most consistent arthroscopic findings in the group of patients who display radiographic changes compatible with Stage I of the disease include fibrillation of the articular cartilage on the ulnar third of the base of the first metacarpal, disruption of the dorsoradial ligament, and diffuse synovial hypertrophy (see Fig. 1). A less reliable discovery is attenuation of the POL.

Regular arthroscopic findings noted in patients classified as having Stage II arthritis include frank eburnation of the articular cartilage of the ulnar third of the metacarpal base and central third of the distal surface of the trapezium, disruption of the DRL, more noticeable attenuation of the POL, and more intense synovial hypertrophy (see Figs. 2 and 3). Most of the patients in this

Fig. 7. External view of thumb base denoting the traction method and ulnar portal placement of the arthro-scope with APL tendon slip insertion via the radial portal.

arthroscopic stage also presented radiographically as Stage II, but on occasion patients deemed Stage I may actually have more advanced findings once the joint is truly assessed. Herein lies one of the great advantages of this technology. Only the rare case demonstrates less cartilage wear than supposed on the plain film. Consequently, radiographic Stage III rarely is considered Stage II, but that does greatly influence and expand the treatment options. Because this stage may have the most clinical impact on our method of treatment, due to lack of good options, it is important to review the patient outcomes for arthroscopic Stage II disease.

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