Clinical Results of A Novel Arthroscopic Microfracture Technique For Chondral Lesions of The Lunate

Abstract PurposeChondral lesions of the lunate are one of the causes of ulnar-sided pain, but there has been little interest to date in treating them. In this paper, we describe a modification of the subchondral drilling technique in which an 18-gauge (G) needle was used as a sleeve to guide a K-wire to the lunate chondral defect.MethodsEleven patients (nine women, two men) who had undergone a simultaneous arthroscopic wafer procedure and lunate microfracture between 2014 and 2017 were retrospectively reviewed. After completion of the arthroscopic wafer procedure, an 18G needle was placed into the joint via the 6R portal and the needle tip was inserted into the subchondral bone. A 0.8-mm K-wire was then advanced through the needle and the lunate was drilled to a 2–3-mm depth. It is possible to safely drill remaining areas by only changing the direction of the needle. ResultsEight patients met inclusion criteria. There was no significant difference between the preoperative and postoperative wrist range of motion (p>0.05). Grip strength was significantly improved postoperatively (p<0.05). According to the Mayo wrist scoring system, six and one patients had excellent and good results, respectively.ConclusionArthroscopic lunate microfracture is an effective treatment for chondral defects of the lunate in the setting of ulnar impaction syndrome, and using a needle as a sleeve can ease manipulation and increase accuracy. Level of Evidence: IV