Open Versus Arthroscopic Reduction for Perilunate and Lunate Dislocations: A Systematic Review and Network Meta-Analysis.

PURPOSE: Perilunate and lunate dislocations represent complex wrist injuries requiring urgent reduction and stabilization. While open reduction has been the gold standard, arthroscopic techniques have emerged as less invasive alternatives. However, comparative evidence remains limited, and the management strategies are controversial.

METHODS

We conducted a systematic review and network meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Dedicated searches of major databases were performed up to June 16, 2025. Studies comparing open and arthroscopic reduction techniques for perilunate/lunate dislocations were included. Primary outcomes included functional scores (Mayo Wrist Score, Disabilities of the Arm, Shoulder, and Hand), whereas secondary outcomes encompassed complications, anatomical success, and grip strength recovery. Network meta-analysis was performed using random-effects models, with Grading of Recommendations Assessment, Development, and Evaluation framework for evidence quality assessment.

RESULTS

Thirty-four studies with total of 962 patients were included (open reduction: 584 patients, arthroscopic: 378 patients). Direct comparative evidence was limited to three studies (48 patients). Arthroscopic reduction demonstrated superior functional outcomes. Complication rates showed advantages for arthroscopic approaches. Subgroup analyses revealed surgeon experience significantly affected outcomes, with experienced surgeons achieving superior results and fewer complications. Greater arc fractures demonstrated higher complication rates regardless of approach.

CONCLUSIONS

Arthroscopic reduction may offer functional advantages over open techniques for perilunate dislocations, especially when performed by experienced surgeons for acute, less complex injuries. However, evidence quality remains low, warranting high-quality randomized trials.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.