What's New in Hand and Wrist Arthroscopy: Indications, Techniques, and Emerging Applications.

Abstract

Wrist arthroscopy has undergone substantial evolution over the past 2 decades, transitioning from a primarily diagnostic procedure to a versatile therapeutic platform with applications across trauma, instability, degenerative disease, and reconstructive surgery. Advances in instrumentation, visualization, and surgical technique have expanded indications while facilitating less invasive management of complex wrist pathology. In acute fracture care, arthroscopy provides direct assessment of articular reduction and associated soft tissue injuries in scaphoid and distal radius fractures, with emerging applications in distal radius malunion correction. Arthroscopic techniques for scaphoid nonunion management have demonstrated high union rates while preserving vascularity and permitting treatment of concomitant intraarticular pathology. Management of ulnar-sided wrist pain continues to expand through arthroscopic triangular fibrocartilage complex repair and reconstruction, distal radioulnar joint assessment, extensor carpi ulnaris tenoscopy, and treatment of pisotriquetral disorders. Arthroscopy also plays an increasing role in the diagnosis and treatment of Kienböck disease, offering minimally invasive options ranging from core decompression and debridement to arthroscopic assisted intercarpal fusion procedures. In the setting of carpal instability, advances in arthroscopic capsulodesis, ligament reconstruction, and treatment algorithms for scapholunate and dorsal intercarpal ligament injuries have broadened therapeutic possibilities. Arthroscopic and arthroscopic assisted procedures for wrist arthritis, including partial wrist arthrodesis, continue to gain acceptance, whereas small joint arthroscopy has expanded indications for fracture management and treatment of select degenerative and inflammatory conditions. Emerging technologies, including dry arthroscopy, needle arthroscopy, augmented reality navigation, robotics, and artificial intelligence-assisted image recognition may further enhance precision and accessibility. This review summarizes contemporary evidence, evolving indications, technical innovations, and future directions in wrist arthroscopy, highlighting its growing role as a central component of modern hand and wrist surgery.