J Wrist Surg 2021; 10(06): 476-483
DOI: 10.1055/s-0040-1716863
Special Review: The Scapholunate Dilemma

Ligamentization and Remnant Integration: Review and Analysis of Current Evidence and Implications for Scapholunate Reconstruction

Tim A.J. Lindsay
1   College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
Harley R. Myers
2   Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred, Melbourne, Victoria, Australia
Stephen Tham
3   Victorian Hand Surgery Associates, Fitzroy, Victoria, Australia
4   St. Vincent's Hand Surgery Unit, St. Vincent's Hospital, Fitzroy, Victoria, Australia
5   Hand and Wrist Biomechanics Laboratory, O'Brien Institute, St Vincents Hospital, Fitzroy, Victoria, Australia
6   Hand Unit, Dandenong Hospital, Dandenong, Victoria, Australia
› Institutsangaben


Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the “ligamentization” of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices.

Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization.

Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria.

Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time.

Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery.

Level of Evidence This is a level I/II, review study.

Supplementary Material


Eingereicht: 04. August 2020

Angenommen: 11. August 2020

Artikel online veröffentlicht:
23. Oktober 2020

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