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MRI Findings More Accurate than Radiographs for Patients with Certain Carpal Arthritis

Located in the most commonly injured joint in the body, traumatic carpal bone fractures can lead to degenerative carpal arthritis patterns in the wrist such as Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC).

While historically used to determine SLAC progression, plain radiographic methods are not always sensitive. Researchers from Hospital for Special Surgery assessed the prevalence of radiolunate (RL) ligament wear in SLAC/SNAC patients by comparing operative findings to MRI and plain radiographs to determine diagnostic accuracy.

This retrospective study looked at 41 patients who underwent wrist surgery between 2006 and 2016 and were diagnosed with SLAC or SNAC with preoperative imaging. This ten-year review utilized operative reports as well as radiographs graded by radiologists using the Kelgran Lawrence Joint Grading Scale.

According to operative and MRI findings, the study found that RL wear occurs in late SLAC/SNAC patients. It was determined that plain radiograph findings underestimate the degree of involvement and that MRI has a potentially higher diagnostic accuracy for detection of RL wear. MRI findings had a stronger correlation with operative pathologic findings than radiograph (p = 0.158 vs. p = 0.337).

The study’s results suggest that surgeons should consider taking a high-resolution MRI prior to joint preserving surgery in the wrist. This knowledge can potentially change the surgical management of SLAC/SNAC osteoarthritis.

Abstract Title: Magnetic Resonance Imaging Findings Correlate with Operative Findings in Patients with SLAC/SNAC Osteoarthritis

Authors: Danielle Christine Marshall, BA; Schneider K. Rancy, BA; Alissa J. Burge, MD; Hollis G. Potter, MD; Scott W. Wolfe, MD; Steve K. Lee, MD.