Arthroscopic Synovectomy of the Metacarpophalangeal and Proximal Interphalangeal Joints

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Few reports about clinical experience in arthroscopy of finger joints exist. Furthermore, little attention has been given to arthroscopic synovectomy of rheumatoid fingers. Herein, we describe our experience with arthroscopic synovectomy of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in patients with rheumatoid arthritis.

Arthroscopic synovectomy was performed in 45 finger joints (18 MCP joints, 26 PIP joints, and 1 interphalangeal thumb joint) of 23 patients with rheumatoid arthritis. All procedures were performed on an outpatient basis under regional anesthesia. The diameter of the arthroscope for small joints was 1.5 mm, and a mini shaver system with a 2.5-mm cutter was used for synovectomy. We developed new portals for PIP joints that were established on the dorsolateral aspect at a position more lateral than previously reported portals.

Intraarticular structures of finger joints were well visualized, and magnified observation of the articular cartilage and synovial membrane was possible. Because insertion of the instruments into the palmar cavity was not possible without causing damage to the articular surfaces, synovectomy of the palmar capsule could not be performed. However, arthroscopic synovectomy of the dorsal capsule under visual control could be safely performed using the 2-portal technique. None of the patients experienced postprocedural complications. Swelling of each joint disappeared after the procedure and did not return in many cases for a long period. Furthermore, no joints required reoperation.

We conclude that arthroscopy of MCP and PIP joints is useful not only for the assessment of articular cartilage and synovium but also for synovectomy in rheumatoid arthritis.

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