Intrinsic ligament lesions can occur after a trauma to the wrist, such as a sprain, a distal radius fracture or a perilunate dislocation. They can also be caused by a micro-traumatic mechanism due to repetitive heavy work, intense sports activities, or congenital factors with progressive attenuation of the ligaments. The identification of these injuries, especially in the early stages, is not easy with standard diagnostic imaging, while arthroscopy is considered the gold standard for identification and classification of them. Early identification is important because treatment provides better results in the early stages, while results are still challenging in the late stages. These injuries are a spectrum of different complex intracarpal ligament lesions, mainly scapholunate and lunotriquetral injuries, with the involvement of different extrinsic ligaments. Open treatments have been used for many years, while the arthroscopic treatments described in this chapter have been proposed in recent years and have the advantage of being minimally invasive. The aim of the treatment is to stabilize the scapholunate and/or lunotriquetral joint to restore painless function and avoid the development of secondary osteoarthritis.