The literature lacks guidelines on treating focal carpal chondral lesions associated with chronic dynamic scapholunate instability (CDSI + C) and provides little information on its distribution.

To report on the distribution and severity of focal chondral lesions in patients with a primary diagnosis of chronic dynamic scapholunate instability and to evaluate a protocol to treat CDSI + C.

We conducted a longitudinal, retrospective study on 255 consecutive arthroscopies from January 2008 to December 2020 with a primary diagnosis of CDSI. We included patients with negative wrist X-rays but positive arthroscopic findings for focal chondral lesions and followed a Debride-First-Then-Wait protocol. During arthroscopy, scapholunate tears were debrided, and focal chondral lesions were treated with chondral shaving to partial carpectomy. A Dynadesis (tendon-to-tendon transfer through the distal scaphoid) or partial fusion was performed if symptoms persisted or reoccurred.

Seventy-nine wrists had 175 focal chondral lesions (grades I–IV), with one to seven lesions per wrist, across 16 different sites, most commonly the radial styloid, scaphoid body, and triquetrum. After a 7.3-year follow-up (range: 2–15 years; 43% followed ≥7 years), 54 wrists (68%) remained satisfied with arthroscopic treatment outcomes, whereas 25 wrists (32%) were treated with open surgery.

Focal carpal chondral lesions can occur even in early stages of scapholunate instability. We identified CDSI + C patients who benefited from minimal intervention using the Debride-First-Then-Wait protocol. From 79 wrists treated with arthroscopic debridement and chondral shaving, 68% did not need further treatment, a Dynadesis was performed for 28% and a partial fusion for 4%.

Level IV

Additional data available at doi: 10.17632/h9jfcgps6n.2

Institutional Review Board approval was obtained on February 22, 2022, from INTEGRIS Health Institutional Review Board. An amendment to increase the accrual goal was granted on July 11, 2023.

The work was performed at Seradge Medical, 13100 N Western Ave, Suite 200, Oklahoma City, OK 73114, United States.

Received: 02 May 2025

Accepted: 12 December 2025

Article published online:
14 January 2026

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