Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results

Abstract

Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained.

Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded.

Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results

Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

Keywords

acute injury of the scapholunate ligament - scapholunate ligament complex - arthroscopy - dorsal capsular reinforcement

Note

This study was performed in Unidad de Cirugía de Mano y Miembro Superior. Hospital Quirónsalud Valencia. Valencia, Spain.

Ethical Approval

This study was approved by the Ethics Committee of the Hospital Quirónsalud Valencia.

• References

• 1 Manuel J, Moran SL. The diagnosis and treatment of scapholunate instability. Hand Clin 2010; 26 (01) 129-144
• 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 Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin 1997; 13 (01) 39-49
• 4 Weiss AP, Akelman E, Lambiase R. Comparison of the findings of triple-injection cinearthrography of the wrist with those of arthroscopy. J Bone Joint Surg Am 1996; 78 (03) 348-356
• 5 Hobby JL, Tom BD, Bearcroft PW, Dixon AK. Magnetic resonance imaging of the wrist: diagnostic performance statistics. Clin Radiol 2001; 56 (01) 50-57
• 6 Geissler WB. Arthroscopic management of scapholunate instability. J Wrist Surg 2013; 2 (02) 129-135
• 7 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
• 8 Berger RA, Landsmeer JMF. The palmar radiocarpal ligaments: a study of adult and fetal human wrist joints. J Hand Surg Am 1990; 15 (06) 847-854
• 9 Overstraeten LV, Camus EJ, Wahegaonkar A. , et al. Anatomical description of the dorsal capsuloscapholunate septum (DCSS). Arthroscopic staging of scapholunate instability after DCSS sectioning. J Wrist Surg 2013; 2 (02) 149-154
• 10 Hixson ML, Stewart C. Microvascular anatomy of the radioscapholunate ligament of the wrist. J Hand Surg Am 1990; 15 (02) 279-282
• 11 Bednar JM. Acute scapholunate ligament injuries: arthroscopic treatment. Hand Clin 2015; 31 (03) 417-423
• 12 Whipple TL. The role of arthroscopy in the treatment of scapholunate instability. Hand Clin 1995; 11 (01) 37-40
• 13 White NJ, Rollick NC. Injuries of the scapholunate interosseous ligament: an update. J Am Acad Orthop Surg 2015; 23 (11) 691-703
• 14 Darlis NA, Kaufmann RA, Giannoulis F, Sotereanos DG. Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability. J Hand Surg Am 2006; 31 (03) 418-424
• 15 Szabo RM. Scapholunate ligament repair with capsulodesis reinforcement. J Hand Surg Am 2008; 33 (09) 1645-1654
• 16 Luchetti R, Atzei A, Cozzolino R, Fairplay T. Current role of open reconstruction of the scapholunate ligament. J Wrist Surg 2013; 2 (02) 116-125
• 17 Kalainov DM, Cohen MS. Treatment of traumatic scapholunate dissociation. J Hand Surg Am 2009; 34 (07) 1317-1319
• 18 Hagert E, Persson JK. Desensitizing the posterior interosseous nerve alters wrist proprioceptive reflexes. J Hand Surg Am 2010; 35 (07) 1059-1066
• 19 Elsaidi GA, Ruch DS, Kuzma GR, Smith BP. Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study. Clin Orthop Relat Res 2004; (425) 152-157
• 20 Mathoulin CL, Dauphin N, Wahegaonkar AL. Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears. Hand Clin 2011; 27 (04) 563-572 , xi
• 21 Del Piñal F. Arthroscopic volar capsuloligamentous repair. J Wrist Surg 2013; 2 (02) 126-128
• 22 Carratalá V, Lucas FJ, Miranda I, Sánchez Alepuz E, González Jofré C. Arthroscopic scapholunate capsuloligamentous repair: suture with dorsal capsular reinforcement for scapholunate ligament lesion. Arthrosc Tech 2017; 6 (01) e113-e120
• 23 Carratalá V, Lucas FJ, Alepuz ES, Guisasola E, Calero R. Arthroscopically assisted ligamentoplasty for axial and dorsal reconstruction of the scapholunate ligament. Arthrosc Tech 2016; 5 (02) e353-e359
• 24 Garcia-Elias M. Carpal instability. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH. , eds. Green's Operative Hand Surgery. Vol. 1, 6th ed. New York, NY: Elsevier Churchill Livingstone; 2011: 465-522
• 25 Desai MJ, Kamal RN, Richard MJ. Management of intercarpal ligament injuries associated with distal radius fractures. Hand Clin 2015; 31 (03) 409-416
• 26 Pomerance J. Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma. J Hand Surg Am 2006; 31 (08) 1380-1386
• 27 Rohman EM, Agel J, Putnam MD, Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am 2014; 39 (10) 2020-2026
• 28 Zarkadas PC, Gropper PT, White NJ, Perey BH. A survey of the surgical management of acute and chronic scapholunate instability. J Hand Surg Am 2004; 29 (05) 848-857
• 29 Melone Jr CP, Polatsch DB, Flink G, Horak B, Beldner S. Scapholunate interosseous ligament disruption in professional basketball players: treatment by direct repair and dorsal ligamentoplasty. Hand Clin 2012; 28 (03) 253-260 , vii
• 30 Swanstrom MM, Lee SK. Open treatment of acute scapholunate instability. Hand Clin 2015; 31 (03) 425-436
• 31 Tommasini Carrara de Sambuy M, Burgess TM, Cambon-Binder A, Mathoulin CL. The anatomy of the dorsal capsulo-scapholunate septum: a cadaveric study. J Wrist Surg 2017; 6 (03) 244-247
• 32 Andersson JK, García-Elías M. Dorsal scapholunate ligament injury: a classification of clinical forms. J Hand Surg Eur Vol 2013; 38 (02) 165-169
• 33 Bickert B, Sauerbier M, Germann G. Scapholunate ligament repair using the Mitek bone anchor. J Hand Surg 2000; 25 (02) 188-192
• 34 Rosati M, Parchi P, Cacianti M, Poggetti A, Lisanti M. Treatment of acute scapholunate ligament injuries with bone anchor. Musculoskelet Surg 2010; 94 (01) 25-32
• 35 Minami A, Kato H, Iwasaki N. Treatment of scapholunate dissociation: ligamentous repair associated with modified dorsal capsulodesis. Hand Surg 2003; 8 (01) 1-6