Reduction and Association of the Scaphoid and Lunate: A Functional and Radiographical Outcome Study
07 February 2018
04 July 2018
07 August 2018 (online)
Background Management of scapholunate (SL) ligament disruption is a challenging problem. The reduction and association of the scaphoid and lunate (RASL) procedure has been described with varying results. This study assessed the outcomes of the RASL procedure.
Purpose The objective of this study was to assess the outcomes of patients undergoing the RASL procedure at our institution in regard to pain relief, range of motion, radiographic and functional outcomes, complications, and reoperations.
Materials and Methods Twelve patients with symptomatic chronic SL instability underwent the RASL procedure. The mean age was 35 years. The mean time from injury to surgery was 40 weeks. The mean follow-up was 89 months. Outcomes included visual analog score for pain, wrist range of motion, grip strength, and Mayo Wrist Scores. Preoperative and postoperative radiographs were reviewed.
Results Pain scores improved in 10 wrists. Range of motion and grip strength worsened. The average Mayo Wrist Score was 63.3. The mean SL diastasis and angle improved, but seven wrists developed progressive degenerative changes, with two requiring a salvage procedure. Symptomatic progressive screw lucency occurred in eight wrists requiring screw removal.
Conclusion The RASL procedure can improve SL widening but has a high rate of early failure and reoperation. Following reoperation, long-term follow-up demonstrates reasonable long-term durability in some cases.
Level of Evidence This is a Level IV, therapeutic case study.
Keywordsscapholunate - RASL - carpal instability - reduction and association - advanced collapse - SL injury
This work was performed at the Mayo Clinic, Rochester, MN.
This study underwent Institutional Review Board (IRB) approval by an internal ethical committee approving the study (IRB number: 15–002433).
- 1 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
- 2 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (01) 125-134
- 3 Links AC, Chin SH, Waitayawinyu T, Trumble TE. Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg Am 2008; 33 (06) 850-856
- 4 Szabo RM, Slater Jr RR, Palumbo CF, Gerlach T. Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results. J Hand Surg Am 2002; 27 (06) 978-984
- 5 Moran SL, Cooney WP, Berger RA, Strickland J. Capsulodesis for the treatment of chronic scapholunate instability. J Hand Surg Am 2005; 30 (01) 16-23
- 6 Kleinman WB, Carroll IV C. Scapho-trapezio-trapezoid arthrodesis for treatment of chronic static and dynamic scapho-lunate instability: a 10-year perspective on pitfalls and complications. J Hand Surg Am 1990; 15 (03) 408-414
- 7 Watson HK, Ryu J, Akelman E. Limited triscaphoid intercarpal arthrodesis for rotatory subluxation of the scaphoid. J Bone Joint Surg Am 1986; 68 (03) 345-349
- 8 Rosenwasser MP, Miyasajsa KC, Strauch RJ. The RASL procedure: reduction and association of the scaphoid and lunate using the Herbert screw. Tech Hand Up Extrem Surg 1997; 1 (04) 263-272
- 9 White NJ, Raskolnikov D, Swart E, Rosenwasser MP. Reduction and association of the scaphoid and lunate (RASL): long-term follow-up of a reconstruction technique for chronic scapholunate dissociation. J Hand Surg Am 2010; 35 (10) 16-17
- 10 Aviles AJ, Lee SK, Hausman MR. Arthroscopic reduction-association of the scapholunate. Arthroscopy 2007; 23 (01) 105.e1-105.e5
- 11 Larson TB, Stern PJ. Reduction and association of the scaphoid and lunate procedure: short-term clinical and radiographic outcomes. J Hand Surg Am 2014; 39 (11) 2168-2174
- 12 Caloia M, Caloia H, Pereira E. Arthroscopic scapholunate joint reduction. Is an effective treatment for irreparable scapholunate ligament tears?. Clin Orthop Relat Res 2012; 470 (04) 972-978
- 13 Cognet JM, Levadoux M, Martinache X. The use of screws in the treatment of scapholunate instability. J Hand Surg Eur Vol 2011; 36 (08) 690-693
- 14 Koehler SM, Guerra SM, Kim JM, Sakamoto S, Lovy AJ, Hausman MR. Outcome of arthroscopic reduction association of the scapholunate joint. J Hand Surg Eur Vol 2016; 41 (01) 48-55
- 15 Manuel J, Moran SL. The diagnosis and treatment of scapholunate instability. Hand Clin 2010; 26 (01) 129-144
- 16 Kobayashi M, Berger RA, Nagy L. , et al. Normal kinematics of carpal bones: a three-dimensional analysis of carpal bone motion relative to the radius. J Biomech 1997; 30 (08) 787-793
- 17 Ruby LK, Cooney III WP, An KN, Linscheid RL, Chao EY. Relative motion of selected carpal bones: a kinematic analysis of the normal wrist. J Hand Surg Am 1988; 13 (01) 1-10