Focal chondral lesions of the wrist and hand are an underrecognized source of pain and functional limitation in athletes. Their management remains challenging due to the limited healing capacity of hyaline cartilage, the biomechanical demands of small joints, and the lack of standardized treatment algorithms. Arthroscopy allows accurate diagnosis and targeted treatment with minimal morbidity, while biologic augmentation using autologous adipose-derived products has emerged as a potential adjunct to improve clinical outcomes.

To evaluate the clinical outcomes of arthroscopic debridement combined with intra- and peri-articular injection of autologous microfragmented adipose tissue in professional athletes affected by focal chondral lesions of the wrist and hand.

This prospective single-center case series included six professional athletes (5 men, 1 woman; mean age 26.3 years) treated between June 2020 and April 2022. A total of nine joints were addressed (3 radiocarpal and 6 metacarpophalangeal). All patients underwent standardized wrist or hand arthroscopy followed by intra- and peri-articular injection of autologous microfragmented adipose tissue processed using a closed mechanical system. Chondral lesions were graded according to the International Cartilage Repair Society classification. Clinical outcomes included pain (visual analog scale, VAS), upper-limb function (QuickDASH), and joint range of motion (ROM), assessed preoperatively and during follow-up. Nonparametric statistical analysis was performed.

At a mean follow-up of 17.5 ± 8.2 months (range, 8–30 months), all patients demonstrated clinically meaningful improvement in pain, function, and joint mobility. Mean VAS scores decreased from 7.2 to 1.5, and QuickDASH scores improved from 36.9 to 8.2. Joint ROM increased across all planes. All athletes returned to their pre-injury competitive level, and activities of daily living were fully resumed within a mean of 4.8 months. No procedure-related complications or reoperations were observed.

Arthroscopic debridement combined with autologous microfragmented adipose tissue injection appears to be a safe and feasible joint-preserving option for the management of focal chondral lesions of the wrist and hand in professional athletes. The observed clinical improvements represent a preliminary signal of benefit and support further investigation in larger comparative studies.