Safety of dorsal wrist arthroscopy portals: A magnetic resonance study

In wrist arthroscopy, the standard dorsal portals are the most commonly used. However, their placement can be associated with injuries to the neurovascular structures of the radiocarpal joint. The present study assessed and compared the distance of commonly used dorsal portals to radial and ulnar neurovascular structures. Forty patients (20 males, 20 females) were evaluated with T1-weighted spin-echo (SE) magnetic resonance (MR) sequences. We measured the distance between 1-2 and 3-4 portals and radial vascular bundle and the nearest branch of the superficial branch of radial nerve (SBRN). We also measured the distance between 4 and 5, 6/U and 6/R and ulnar vascular bundle and the nearest branch of the dorsal ulnar nerve (DUN). The median age of patients was 39 years (95% IC 36.97-43.32 years). The 3-4 portal was farther away from the vascular structure than the 1-2 portal (P < 0.0001), 4-5 portal (P = 0.008), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). Moreover, the 3-4 portal was farther away from the nerve branch than the 1-2 portal (P < 0.0001), 4-5 portal (P < 0.0001), 6/R (P < 0.0001), and 6/U portals (P < 0.0001). No statistical significant differences were found between the two genders. The 3-4 and 4-5 portals are the farthest away from the neurovascular structures, and likely reduce the risk to damage these structures. On the other hand, the 1-2 and 6/U portals likely increase the risk of neurovascular damage, because of their proximity to neurovascular structures.

Diagnostic study; Level III.