Download PDF
J Wrist Surg 2019; 08(02): 124-131
DOI: 10.1055/s-0038-1676865
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Carpal Kinematics following Sequential Scapholunate Ligament Sectioning

Clare E. Padmore
1   Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
2   The University of Western Ontario, London, Ontario, Canada
,
Helen Stoesser
1   Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
2   The University of Western Ontario, London, Ontario, Canada
,
G. Daniel G. Langohr
1   Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
2   The University of Western Ontario, London, Ontario, Canada
,
James A. Johnson
1   Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
2   The University of Western Ontario, London, Ontario, Canada
,
Nina Suh
1   Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
2   The University of Western Ontario, London, Ontario, Canada
› Author Affiliations Funding Dr. Johnson reports grants from the Canadian Institutes of Health Research Program Grant during the conduct of the study.
Further Information

Publication History

07 February 2018

12 November 2018

Publication Date:
17 January 2019 (online)

   Permissions and Reprints

Abstract

Background The scapholunate ligament (SLL) is the most commonly injured intercarpal ligament of the wrist. It is the primary stabilizer of the scapholunate (SL) joint, but the scaphotrapeziotrapezoid (STT) and radioscaphocapitate (RSC) ligaments may also contribute to SL stability. The contributions of SL joint stabilizers have been reported previously; however, this study aims to examine their contributions to SL stability using a different methodology than previous studies.

Purpose The purpose of this in vitro biomechanical study was to quantify changes in SL kinematics during wrist flexion and extension following a previously untested sequential sectioning series of the SL ligament and secondary stabilizers.

Methods Eight cadaveric upper extremities underwent active wrist flexion and extension in a custom motion wrist simulator. SL kinematics were captured with respect to the distal radius. A five-stage sequential sectioning protocol was performed, with data analyzed from 45-degree wrist flexion to 45-degree wrist extension.

Results Wrist flexion and extension caused the lunate to adopt a more extended posture following sectioning of the SLL and secondary stabilizers compared with the intact state (p < 0.009). The isolated disruption to the dorsal portion of the SLL did not result in significant change in lunate kinematics compared with the intact state (p > 0.05). Scaphoid kinematics were altered in wrist flexion following sequential sectioning (p = 0.013). Additionally, disruption of the primary and secondary stabilizers caused significant change to SL motion in both wrist flexion and wrist extension (p < 0.03).

Conclusions The SLL is the primary stabilizer of the SL articulation, with the STT and RSC ligaments playing secondary stabilization roles.

Clinical Relevance Understanding the role primary and secondary SL joint stabilizers may assist in the development of more effective treatment strategies and patient outcomes following SLL injuries.

Keywords

scapholunate instability - wrist - biomechanics

All work was performed at the Hand and Upper Limb Clinic, London, Ontario.


 

  • References

  • 1 Wolfe SW, Neu C, Crisco JJ. In vivo scaphoid, lunate, and capitate kinematics in flexion and in extension. J Hand Surg Am 2000; 25 (05) 860-869
    CrossrefPubMedGoogle Scholar
  • 2 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
    CrossrefPubMedGoogle Scholar
  • 3 Johnson JE, Lee P, McIff TE, Toby EB, Fischer KJ. Effectiveness of surgical reconstruction to restore radiocarpal joint mechanics after scapholunate ligament injury: an in vivo modeling study. J Biomech 2013; 46 (09) 1548-1553
    CrossrefPubMedGoogle Scholar
  • 4 Werner FW, Dimitris C, Joyce DA, Harley BJ. Force in the scapholunate interosseous ligament during physiological wrist loading. J Hand Surg Am 2015; 40 (08) 1-9
    CrossrefPubMedGoogle Scholar
  • 5 Kuo CE, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2008; 33 (06) 998-1013
    CrossrefPubMedGoogle Scholar
  • 6 Ruby LK, An KN, Linscheid RL, Cooney III WP, Chao EYS. The effect of scapholunate ligament section on scapholunate motion. J Hand Surg Am 1987; 12 (5 Pt 1): 767-771
    CrossrefPubMedGoogle Scholar
  • 7 O'Meeghan CJ, Stuart W, Mamo V, Stanley JK, Trail IA. The natural history of an untreated isolated scapholunate interosseus ligament injury. J Hand Surg Br 2003; 28 (04) 307-310
    CrossrefPubMedGoogle Scholar
  • 8 Cooney W. III, ed The Wrist: Diagnosis and Operative Treatment. In: Kluwer W. , ed. Vol. 8. 2nd ed. Rochester, MN: Wolters Kluwer; 2011
    Google Scholar
  • 9 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
    CrossrefPubMedGoogle Scholar
  • 10 Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 1999; 24 (05) 953-962
    CrossrefPubMedGoogle Scholar
  • 11 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part II. J Hand Surg Am 2005; 30 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 12 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (06) 991-1002
    CrossrefPubMedGoogle Scholar
  • 13 Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 1995; 20 (06) 986-999
    CrossrefPubMedGoogle Scholar
  • 14 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
    PubMedGoogle Scholar
  • 15 Waters MS, Werner FW, Haddad SF, McGrattan ML, Short WH. Biomechanical evaluation of scaphoid and lunate kinematics following selective sectioning of portions of the scapholunate interosseous ligament. J Hand Surg Am 2016; 41 (02) 208-213
    CrossrefPubMedGoogle Scholar
  • 16 Lavernia CJ, Cohen MS, Taleisnik J. Treatment of scapholunate dissociation by ligamentous repair and capsulodesis. J Hand Surg Am 1992; 17 (02) 354-359
    CrossrefPubMedGoogle Scholar
  • 17 Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin 1987; 3 (01) 81-102
    Google Scholar
  • 18 Weiss A-P. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (02) 205-215
    CrossrefPubMedGoogle Scholar
  • 19 Watson HK, Weinzweig J, Guidera PM, Zeppieri J, Ashmead D. One thousand intercarpal arthrodeses. J Hand Surg Br 1999; 24 (03) 307-315
    CrossrefPubMedGoogle Scholar
  • 20 Kleinman WB. Long-term study of chronic scapho-lunate instability treated by scapho-trapezio-trapezoid arthrodesis. J Hand Surg Am 1989; 14 (03) 429-445
    CrossrefPubMedGoogle Scholar
  • 21 Wyrick JD, Stern PJ, Kiefhaber TR. Motion-preserving procedures in the treatment of scapholunate advanced collapse wrist: proximal row carpectomy versus four-corner arthrodesis. J Hand Surg Am 1995; 20 (06) 965-970
    CrossrefPubMedGoogle Scholar
  • 22 Wyrick JD, Youse BD, Kiefhaber TR. Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation. J Hand Surg Br 1998; 23 (06) 776-780
    CrossrefPubMedGoogle Scholar
  • 23 Werner FW, Short WH, Green JK. Changes in patterns of scaphoid and lunate motion during functional arcs of wrist motion induced by ligament division. J Hand Surg Am 2005; 30 (06) 1156-1160
    CrossrefPubMedGoogle Scholar
  • 24 Iglesias D. (2015). Development of an In-Vitro Passive and Active Motion Simulator for the Investigation of Wrist Function and Kinematics. Electronic Thesis and Dissertation Repository, University of Western Ontario. http://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=3380&context=etd .
    PubMedGoogle Scholar
  • 25 Wu G, van der Helm FCT, Veeger HEJ. , et al; International Society of Biomechanics. ISB recommendation on definitions of joint coordinate systems of various joints for the reporting of human joint motion--part II: shoulder, elbow, wrist and hand. J Biomech 2005; 38 (05) 981-992
    CrossrefPubMedGoogle Scholar
  • 26 Werner FW, Palmer AK, Somerset JH. , et al. Wrist joint motion simulator. J Orthop Res 1996; 14 (04) 639-646
    CrossrefPubMedGoogle Scholar
  • 27 Pollock PJ, Sieg RN, Baechler MF, Scher D, Zimmerman NB, Dubin NH. Radiographic evaluation of the modified Brunelli technique versus the Blatt capsulodesis for scapholunate dissociation in a cadaver model. J Hand Surg Am 2010; 35 (10) 1589-1598
    CrossrefPubMedGoogle Scholar
  • 28 Lee SK, Zlotolow DA, Sapienza A, Karia R, Yao J. Biomechanical comparison of 3 methods of scapholunate ligament reconstruction. J Hand Surg Am 2014; 39 (04) 643-650
    CrossrefPubMedGoogle Scholar
  • 29 Short WH, Werner FW, Sutton LG. Treatment of scapholunate dissociation with a bioresorbable polymer plate: a biomechanical study. J Hand Surg Am 2008; 33 (05) 643-649
    CrossrefPubMedGoogle Scholar