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J Wrist Surg
DOI: 10.1055/a-2698-9750
Procedure

Midcarpal Ultra-wide Scapholunotriquetral Capsulo-ligamentoplasty (MUSCL) Procedure

Authors

  • Eleanor Ruth Houghton 

    1   Royal National Orthopaedic Hospital, Stanmore, United Kingdom
    2   Macquarie Hand Unit, Macquarie University, New South Wales, Australia

  • Brahman Sivakumar 

    3   Department of Hand and Peripheral Nerve Surgery, Royal North Shore Hospital, St Leonards, NSW, Australia
    4   Department of Orthopaedic Surgery, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia
    5   Department of Orthopaedic Surgery, Nepean Hospital, Kingswood, New South Wales, Australia
    6   Faculty of Medicine and Health, Sydney Medical School, the University of Sydney, Camperdown, New South Wales, Australia
    7   Australian Research Collaboration on Hands [ARCH], Mudgeeraba, Queensland, Australia

  • Nina Thompson 

    8   Macquarie Hand Therapy, Macquarie University Hospital, New South Wales, Australia

  • Nicholas Charles Smith 

    2   Macquarie Hand Unit, Macquarie University, New South Wales, Australia
    9   Macquarie Hand Unit, Faculty of Medicine and Health Sciences, Macquarie University, New South Wales, Australia

Funding Information None.
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Abstract

Background

Arthroscopic dorsal capsuloligamentous reconstruction (ADCLR) has gained popularity in addressing symptomatic scapholunate instability without radiographic malalignment (European Wrist Arthroscopy Society [EWAS] grade IIIB/IIIC/IV).

Case Description

A midcarpal ultra-wide version of the ADCLR is described, wherein suture needles are directly inserted into the midcarpal joint without prior entry into the radiocarpal joint. A wide “bite” is taken to plicate the dorsal radiocarpal (DRC), dorsal intercarpal (DIC), and dorsal scapholunotriquetral (DSLT) ligaments. An incision is then performed to allow direct visualization suture passage beneath the extensor tendons. A total of 68 consecutive patients received a midcarpal ultra-wide scapholunotriquetral capsulo-ligamentoplasty (MUSCL) between July 2020 and November 2023. Mean follow-up was 8 months (range 2–24 months). The mean pre- and postoperative range of dorsiflexion was 64.54 and 68.32 degrees, respectively (p = 0.14). The mean preoperative and postoperative range of palmarflexion was 71.89 and 67.18 degrees, respectively (p = 0.18). A significant improvement of 35.19 points was noted in mean QuickDASH score post-surgery (p < 0.001).

Literature Review

Several modifications of the ADCLR exist, including those that take a wider bite incorporating capsule from the mid-carpal joint as well as augmentations with capsuloligamentous imbrications and suture anchor repairs. These approaches yield good pain relief, improved range of motion, and enhanced grip strength when compared with open techniques.

Clinical Relevance

This technique eliminates the challenging maneuver of passing needles from the radiocarpal joint into the midcarpal joint, offering both procedural simplicity and efficacy, with promising short-term outcomes. Long-term follow-up is necessary.

Keywords

scapholunate instability - ADCLR - MUSCL - midcarpal ultra-wide scapholunotriquetral capsulo-ligamentoplasty - arthroscopic dorsal capsuloligamentous reconstruction

Contributors' Statement

E.H.: wrote the manuscript. All authors reviewed and edited the manuscript and approved the final version of the manuscript.


Informed Consent

Written informed consent was obtained from the patients for their anonymized information and intraoperative photographs to be published in the article.




Publikationsverlauf

Eingereicht: 09. März 2025

Angenommen: 01. September 2025

Artikel online veröffentlicht:
25. September 2025

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