The evolving role of wrist arthroscopy

Wrist arthroscopy is a valuable tool in hand surgery. However, as with every tool, its use must be executed by the right hands with the right training and right instrumentation. In this article, four papers on arthroscopy were examined for their contribution to the literature and to reflect on the evolving role of arthroscopy in hand surgery. The dorsal sensory branch of the ulnar nerve remains vulnerable with the placements of ulnar portals. Building from previous work, a 'nerve density' concept was presented, as it relates to wrist pronation and supination. The advent of arthroscopy has allowed the closed repair of triangular fibrocartilage complex injuries with better healing potential. Well-defined anatomical landmarks allow more precise placement of suture materials which need to be used judiciously to avoid further injuries. Likewise, scaphoid non-union can be successfully treated as a closed procedure using arthroscopy. A surgeon's learning journey was revealed as a change in practice to obtain the best results. Perilunate injuries can also be treated arthroscopically, but the problems related to bone-ligament interface healing remain unsolved. These publications reflect the increasing usage of this valuable tool and the lessons learnt would further optimize results and avoid pitfalls. Major breakthroughs in wrist arthroscopy in the near future may be obtained through better training and education. Research into the healing of the bone-ligament interface would allow more judicious use of implants.