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J Wrist Surg 2023; 12(03): 218-224
DOI: 10.1055/s-0042-1757441
Scientific Article

Clinical Outcomes of Arthroscopic Ligament-Sparing Dorsal Capsulodesis for Partial Scapholunate Ligament Tear

Matthew W. T. Curran
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
2   Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
,
Stefanie Wieschollek
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
2   Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
,
Ruby Strauss 
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
,
Silvia Manzanero 
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
,
Benjamin Hope
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
2   Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
,
Greg Couzens
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
2   Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
3   Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
,
Mark Ross 
1   Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
2   Department of Orthopaedics, The Princess Alexandra Hospital, Brisbane, Australia
4   School of Medicine, The University of Queensland, Brisbane, Australia
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of the article. The Brisbane Hand and Upper Limb Research Institute receives institutional support and fellowship support from Newclip Technics, Johnson & Johnson (DePuy Synthes), Exactech, Integra LifeSciences, and LMT Surgical.
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Abstract

Introduction Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tightening yields reliable and satisfactory results for the management of partial SLL tears.

Methods A prospective cohort study was conducted on adult (age ≥18 years) patients with chronic partial SLL tears. All patients failed a trial of conservative management consisting of scapholunate strengthening exercises. Patients underwent an arthroscopic dorsal capsular tightening of the radiocarpal joint capsule radial to the origin of the dorsal radiocarpal ligament and proximal to the dorsal intercarpal ligament by either thermal shrinkage or dorsal capsule abrasion. Demographic data, radiological outcomes, patient-rated outcome measures and objective measures of wrist range of motion (ROM), and grip and pinch strength were recorded. Postoperative outcome scores were collected at 3, 6, 12, and 24 months. Data are reported as median and interquartile range, and comparisons were drawn between baseline and last follow-up. Clinical outcome data were analyzed using a linear mixed model method, while radiographic outcomes were assessed with nonparametric analysis with p < 0.05 indicating statistical significance.

Results Twenty-three wrists (22 patients) underwent SLL treatment by thermal capsular shrinkage (19 wrists) or dorsal capsular abrasion (4 wrists). Median age at surgery was 41 years (range: 32–48) and median follow-up time was 12 months (range: 3–24). Pain significantly decreased from 62 (45–76) to 18 (7–41) and satisfaction significantly increased from 2 (0–24) to 86 (52–92). Patient-Rated Wrist and Hand Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand significantly improved from 68 (38–78) to 34 (13–49) and from 48 (27–55) to 36 (4–58), respectively. Median grip and tip pinch strength significantly increased at final review. Range of movement and lateral pinch strength were satisfactory and maintained. Four patients required further surgery for ongoing pain or reinjury. All were successfully managed with partial wrist fusion or wrist denervation.

Conclusion Arthroscopic ligament-sparing dorsal capsular tightening is a safe and effective treatment for partial SLL tears. Dorsal capsular tightening demonstrates good pain relief and patient satisfaction while improving patient-reported outcomes, grip strength, and maintaining ROM. Longer term studies are required to determine the longevity of these results.

Keywords

scapholunate ligament - arthroscopy - capsulodesis - dorsal

Ethical Approval

Ethical approval was obtained from the Brisbane Private Hospital Low Risk Ethics Committee (LREC/18/BPH/1).




Publication History

Received: 21 February 2022

Accepted: 01 August 2022

Article published online:
07 October 2022

© 2022. Thieme. All rights reserved.

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