**12. Arthroscopic arthrolysis**

Arthroscopic wrist arthrolysis is indicated in situations of posttraumatic wrist rigidity. It can be performed in radiocarpal joint, midcarpal joint and even in DRUJ. The most frequent clinical pathological conditions are adhesive capsulitis and arthrofibrosis of the wrist. Capsulitis is due to ligament and/or capsule contractures, and wrist arthrofibrosis is usually due to osseous band fibrosis of the radius and/or first row carpal bone(s) from a radius articular fracture. These two conditions can be associated in the same case [87]. The technique of the arthroscopic arthrolysis of the wrist was presented by R. Luchetti et al. in 2006. In radiocarpal joint almost all possible portals, including volar portals must be used during this surgery. It could be difficult to orient in the joint and to triangulate instruments because of the fibrotic adhesions inside the joint. Once they are removed (**Figure 38a,** and **b**), but

**Figure 38.** *Intraarticular adhesions (a) after removal (b).*

#### *Wrist Arthroscopy DOI: http://dx.doi.org/10.5772/intechopen.99191*

the range of motion (ROM) is still insufficient, resection of the volar and dorsal radiocarpal ligaments is recommended. This can be done with miniblade, laser or radiofrequency cutter. It's also recommended to leave dorsal and volar ulnar ligaments intact. The midcarpal joint also has to be inspected in the same manner but ligament resection is not recommended. Wrist stiffness is much more rarely attributable to the midcarpal joint, and any fibrosis in this joint is rarely significant [88]. Arthroscopic arthrolysis of the DRUJ is technically very challenging, because visualization of this joint is already problematic in the normal conditions and requires good arthroscopic skills of the surgeon. But once it can be done, patients achieve an improvement of prono/supination movements. If the arthroscopic arthrolysis of the DRUJ cannot be performed because of the technical difficulties it can be conversed to open surgery. Rehabilitation is started immediately after the surgery.

Complications – in cases when osteochondral lesions of various severity are present during the procedure of the arthrolysis, it is quite common for fibrotic bridges to reform in a few months and provoke partial or complete radiocarpal ankylosis. The use of articular instruments and motorized instruments can cause unwanted osteoarticular lesions (chondral scuffing, ligament injuries etc.) that can manifest themselves postoperatively in the form of pain or wrist instability [87, 89].
