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J Wrist Surg 2022; 11(01): 062-068
DOI: 10.1055/s-0041-1732411
Scientific Article

Treatment Recommendations for Suspected Scapholunate Ligament Pathology

Daniel Bakker
1   Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin, Austin, Texas
2   Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
,
Joost T.P. Kortlever
1   Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin, Austin, Texas
3   Department of Orthopaedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
,
Gerald A. Kraan
2   Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
,
Nina Mathijssen
2   Department of Orthopaedic Surgery, Reinier de Graaf Groep, Delft, The Netherlands
,
Joost W. Colaris
4   Department of Orthopaedic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
,
David Ring
1   Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin, Austin, Texas
,
The Science of Variation Group › Author Affiliations Funding None.
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Abstract

Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology.

Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed.

Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight.

Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology.

Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs.

Level of Evidence Not applicable.

Keywords

scapholunate ligament - wrist arthroscopy - Geissler grade - tenodesis - capsulodesis - direct repair

* For The Science of Variation Group members, please refer to Appendix A


Ethical Approval

Ethical approval for this study was waived by the daily board of the medical ethics committee Erasmus MC (MEC-2018–1351). This study was completed in accordance with the Helsinki Declaration as revised in 2013


Authors' Contributions

D.B., J.K., G.K., J.C., N.M., and D.R. contributed in the initial idea and design of the study, and in drafting and finalizing of the manuscript. They also provided the final approval.




Publication History

Received: 26 April 2021

Accepted: 10 June 2021

Article published online:
28 July 2021

© 2021. Thieme. All rights reserved.

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