Wrist arthroscopy through a volar radial portal.

PURPOSE: To quantitatively describe the neurovascular relationships of a volar radial wrist arthroscopy portal and to evaluate whether volar wrist arthroscopy identified additional pathology of the dorsal capsular structures and the palmar region of the scapholunate interosseous ligament that was not seen through the dorsal portals.

TYPE OF STUDY: This study was an anatomic study and retrospective chart review.

METHODS: Cadaver dissections established the neurovascular anatomy of the volar radial portal. Measurements were taken from the portal to the radial artery and its superficial palmar branch; the superficial radial nerve, the median nerve, and its palmar cutaneous branch; and the pronator quadratus. A dorsal capsulotomy was performed to assess the ligamentous interval. A chart review of 30 patients in whom a volar radial portal was used was performed. Intraoperative pathology identified through volar wrist arthroscopy that was not visible through a dorsal portal was recorded. Postoperative neurovascular complications were noted.

RESULTS: There was a greater than 3 mm safe zone surrounding the portal that was free of any neurovascular structures. There were no complications from the use of the portal. Additional pathology that was not visible from a dorsal portal was identified in 10 cases. This included 1 case of hypertrophic synovitis of the dorsal capsule, 1 patient with an avulsion of the radioscapholunate ligament, 1 patient with a tear restricted to the palmar region of the scapholunate interosseous ligament, and 7 patients with tears of the dorsal radiocarpal ligament.

CONCLUSIONS: This study provides a safe, standardized approach to the volar radial aspects of the radiocarpal and midcarpal joints. Volar wrist arthroscopy identified additional pathology of the palmar scapholunate interosseous ligament and dorsal capsular structures in 30% of the patients. The volar radial portal should be considered for inclusion in the arthroscopic examination of any patient with radial-sided wrist pain.