Background In recent years, new arthroscopic techniques have been introduced to address the irreparable tears of the triangular fibrocartilage complex (TFCC) (Palmer type 1B, Atzei class 4) by replicating the standard Adams–Berger procedure. These techniques, however, show the same limitations of the open procedure in relation to the anatomically defective location of the radial origins of the radioulnar ligaments (RUL) and the risk of neurovascular and/or tendon injury. Aiming to improve the quality of reconstruction and reduce surgical morbidity, a novel arthroscopic technique was developed, with the advantages of reproducing the anatomical origins of the RUL ligaments and providing all-inside tendon graft (TG) deployment and fixation. Description of Technique The Allinside anatomic arthroscopic (3A) technique is indicated for TG reconstruction of irreparable TFCC tears in the absence of distal radioulnar joint (DRUJ) arthritis. Standard wrist arthroscopy portals are used. A small incision in the radial metaphyseal area and arthroscopic control are required to set a Wrist Drill Guide and create two converging tunnels, whose openings are at the radial anatomical origins of the RUL. An ulnar tunnel is drilled at the fovea from inside-out via the 6U portal. A 3-mm tendon strip, from the palmaris longus or extensor carpi radialis brevis, is woven through the tunnels and then secured into the ulnar tunnel with an interference screw. Postoperative immobilization with restricted forearm rotation is discontinued at 5 weeks, and then postoperative rehabilitation is started. Patients and Methods The 3A technique was applied on 5 patients (2 females and 3 males), with an average age 42 years. DRUJ stability, range of motion (ROM), pain (0–10 visual analogue scale [VAS]), grip strength, modified Mayo wrist score (MMWS), and patient satisfaction were used for evaluation before surgery and at follow-up. Results No intraoperative or early complications were registered. At a mean follow-up of 26 months, DRUJ was stable in all patients, which recovered 99% ROM. Pain VAS decreased from 7 to 0.6. Grip strength increased from 38 to 48.8 Kgs. There were 4 excellent results and 1 good result on MMWS. All patient showed high satisfaction. Conclusions Although the 3A technique requires dedicated instrumentation and arthroscopic expertise, it takes advantage of improved intra-articular vision and minimized surgical trauma to reduce the risk of complications and obtain promising functional results.

The triangular fibrocartilage complex (TFCC) is the most important stabilizer of the distal radioulnar joint (DRUJ). Its injury is the main cause for ulnar sided pain after wrist trauma. In recent years, advancements of wrist arthroscopy improved the diagnostics and treatment of the TFCC tears. The purpose of this article is to describe a variant of radial tears (1D according to Palmer), in which the radio‐ulnar ligaments were ruptured in the midsubstance just before (Pre) their insertion on the sigmoid notch and illustrate the arthroscopic surgical technique used for its treatment. We name this variant of the Palmer 1D lesion, the pre‐1D TFCC lesion. Technique Video: video See video under supplementary data.

Fracture of the base of the thumb metacarpal (M1) is a common finding in hand trauma. Closed reduction and K‐wire fixation and open reduction–internal fixation are traditional treatments of choice. The arthroscopic assisted technique has been introduced to improve intra‐articular fragment reduction and to preserve fragment vascularization and capsular and ligamentous integrity along with joint stability. Indications for arthroscopic assistance are all types of intra‐articular fractures or pending malunions involving the base of M1 and/or the trapezium. The aim of this article is to describe the surgical technique used in managing articular fractures of the base of M1, with arthroscopic assistance. Our experience with this technique confirms the advantages of a minimally invasive method that provides articular reduction under direct vision, with limited soft‐tissue damage, and allows early rehabilitation (from day 1 after surgery). This technique is extremely valuable for high‐demand patients such as manual workers or athletes. The relative disadvantage of the technique is its technical difficulty, which requires experience with small‐joint arthroscopy. Technique Video: video See video under supplementary data.

Autologous fat injection into osteoarthritic joints (liparthroplasty) has shown high potential in reducing pain and delaying the need for surgical intervention. The liparthroplasty is an alternative and minimally invasive treatment approach for finger and thumb carpometacarpal joint osteoarthritis with only a few studies available. A systematic literature review was performed with a search strategy in MEDLINE databases Google Scholar and Cochrane Library using the following keywords: autologous fat grafting injection, adipose-derived stem cells, finger osteoarthritis, basal thumb ostheoarthritis, lipofilling. The database was analyzed from inception to August 1st, 2023. About 148 studies were identified; 17 additional articles were found through previous publications (total 165 articles). A total of 150 records resulted after duplicates were removed. Fourteen studies were selected and only 10 respected the inclusions criteria. In all these studies, intra-articular injection of autologous fat into osteoarthritic finger joints and trapeziometacarpal joint reduced pain and improved hand function. The liparthroplasty of osteoarthritic finger joints seems to be a minimally invasive, secure, and valid substitute for traditional surgical interventions. While the outcomes are promising, the lack of a standardized technique to fat processing and the absence of randomized controlled trials impede a thorough assessment of the procedures effectiveness.

Two-column midcarpal arthrodesis (2CMA) after scaphoidectomy is a well-established procedure for treating advanced wrist arthritis, particularly scapholunate advanced collapse and scaphoid nonunion advanced collapse grade III wrists. This study evaluates the clinical and radiographic outcomes of 2CMA using headless compression screws (HCS) over a 21-year period.From 2001 to 2022, 128 patients underwent 2CMA at two institutions. Preoperative arthroscopy was performed to confirm the integrity of the radiolunate joint. Outcomes were assessed using the Modified Mayo Wrist Score (MMWS), Disability of the Arm, Shoulder, and Hand (DASH) questionnaire, Patient-Reported Wrist Evaluation (PRWE), and radiographic analysis. Statistical analyses were conducted to compare pre- and postoperative outcomes.At a mean follow-up of 45 months, patients demonstrated significant improvements in pain (Visual Analogue Scale at rest: 2.0–0.6; under stress: 8.0–2.0; p < 0.001) and functional scores (MMWS: 27–69; DASH: 73–37; PRWE: 79–26; p < 0.001). Wrist range of motion improved from 61 to 81 degrees (p < 0.001), and grip strength increased from 19 to 28 kg (58–83% of the contralateral side, p < 0.05). Radiographic bone fusion was confirmed in 99% of cases, with a low complication rate of 4%, including two cases of radiocarpal arthropathy requiring total wrist fusion.The 2CMA technique with HCS achieved excellent pain relief, improved functionality, and high rates of bone consolidation. Compared with traditional four-corner arthrodesis, this approach avoids unnecessary joint fusion, preserving partial wrist mobility. The complications observed were minor and effectively managed.2CMA using HCS is a reliable technique for treating advanced wrist arthritis, providing durable pain relief, functional improvement, and high fusion rates. Further studies comparing this approach with other arthrodesis techniques are warranted.

Background/Objectives: Breast cancer was the leading cause of malignant tumors among women in 2022. About two-thirds of breast cancer cases are hormone-receptor-positive. In these patients, aromatase inhibitors are a mainstay of treatment, but associated musculoskeletal symptoms can negatively affect patient compliance. Aromatase-inhibitor-induced carpal tunnel syndrome represents one of the main causes of aromatase inhibitor discontinuation, with a non-compliance rate of up to 67%, potentially leading to increased cancer mortality. This study investigates estrogen receptor expression in aromatase-inhibitor-induced carpal tunnel syndrome tissues, in order to better define its etiopathogenesis and derive preventive or therapeutic measures that can improve aromatase inhibitor patient compliance. To our knowledge, there is no study on this subject in the literature. Methods: Between 2023 and 2024, we recruited 14 patients at the Jewish Hospital of Rome, including seven patients with aromatase-inhibitor-induced carpal tunnel syndrome (study group) and seven with postmenopausal idiopathic carpal tunnel syndrome (control group). Each patient was evaluated based on a clinical visit, a questionnaire, instrumental exams, and serum hormone dosages and were treated with open carpal tunnel release surgery, during which transverse carpal ligament and flexor tenosynovium samples were collected. For immunohistochemical experiments, sections were treated with anti-estrogen receptor α and anti-estrogen receptor β antibodies. Results: The immunohistochemical features in the study and control groups were similar, demonstrating that tissues affected by aromatase-inhibitor-induced carpal tunnel syndrome are targets of direct estrogen action and that estrogen deprivation is correlated with disease etiogenesis. Surgery was effective in patient treatment. Conclusions: Aromatase-inhibitor-induced carpal tunnel syndrome represents a newly defined form of the disease. This syndrome represents one of the main causes of aromatase inhibitor discontinuation, due to its negative impact on the patient’s quality of life. The identification by clinicians of aromatase inhibitor use as a possible risk factor for carpal tunnel syndrome development is of essential importance, as early diagnosis and prompt management can improve patient compliance and overall breast cancer treatment outcomes.