Midcarpal tenodeses versus partial arthrodeses for stage II SLAC/SNAC wrists: Long-term outcomes from a single-surgeon comparative series

Background: Stage II scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) are commonly treated with partial arthrodeses or motion-preserving techniques such as midcarpal tenodeses. Comparative evidence with long-term follow-up remains limited. Purpose: To compare long-term clinical and functional outcomes of midcarpal tenodeses and partial arthrodeses in patients with stage II SLAC/SNAC, by evaluating grip strength, range of motion, patient-reported outcomes, and reoperation rates. Methods: A retrospective review was performed on 21 patients operated by a single surgeon with a mean follow-up of 103 months. Nine underwent midcarpal tenodeses (FCR or ECRB based), and twelve underwent partial arthrodeses (four-corner fusion or capitolunate fusion). Outcomes included grip strength, range of motion, radiographs, and PROMs (VAS, DASH, PRWE, Mayo Wrist Score). Results: Both procedures produced comparable long-term outcomes. Mean postoperative grip strength was 27.9 kg (~75% of the contralateral side). PROMs were similar between groups (DASH 12.1, PRWE 15.5). Importantly, no complications, non-unions, or conversions to salvage arthrodesis occurred in either group during long-term follow-up. Conclusion: Midcarpal tenodeses and partial arthrodeses yield similarly durable outcomes in stage II SLAC/SNAC wrists. Tenodeses preserve motion and are suitable for patients with preserved cartilage, whereas partial arthrodeses offer predictable stability when midcarpal degeneration is present. Treatment should be individualized according to cartilage status, functional demands, and patient expectations.