Abstract
Objective
Scapholunate interosseus ligament (SLIL) disruption is a challenging injury that presents
with varying degrees of severity. The gold standard diagnosis is arthroscopic evaluation
of the SLIL, but treatments have traditionally been performed with open surgical technique.
This offers powerful correction, but outcomes are inconsistent, and postoperative
stiffness is common. There is a paucity of methods for the management of mild SLIL
instability, and the morbidity of open techniques may be difficult to justify in these
situations. The development of arthroscopic techniques has expanded options to include
repair while minimizing soft tissue disruption. This study presents an arthroscopic
algorithm for the treatment of predynamic SLIL instability without radiographic deformity,
with a case series demonstration of a dorsal and combined volar-dorsal repair.
Materials and Methods
Following institutional review board approval, eight patients with clinical symptoms
of SLIL injury who underwent diagnostic arthroscopy between November 2021 and July
2023 were identified for inclusion in our retrospective review. Repair techniques,
including dorsal capsuloligamentous, as well as combined volar-dorsal suture arthroscopic
repair, were performed based on injury severity in accordance with the European Wrist
Arthroscopy Society (EWAS) grading system, including patients with grade 3 injuries.
Pre- and postoperative range of motion, patient-rated outcomes measures, and radiographic
metrics were assessed for all patients. Patients with scapholunate diastasis were
excluded from this study and treated with alternative interventions.
Results
Median age of the population was 29.5 years, and included six right-sided and two
left-sided injuries. Mean time to follow-up was 18.9 months. No patients presented
with dorsal intercalated segment instability, and there was minimal change in alignment
and scapholunate gapping postoperatively. Following the intervention, patients had
excellent subjective function and range of motion.
Conclusion
We describe a simple and effective suture-based arthroscopic capsuligamentous repair
to treat SLIL injuries that are EWAS grade IIIA to C that resulting in excellent postoperative
motion, function, and reduction of pain.
Level of Evidence
Level IV/Therapeutic.
Keywords
scapholunate interosseous ligament - repair - wrist arthroscopy
