J Wrist Surg 2013; 02(02): 160-167
DOI: 10.1055/s-0032-1333426
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Dorsal Wrist Capsular Tears in Association with Scapholunate Instability: Results of an Arthroscopic Dorsal Capsuloplasty

Adeline Cambon Binder
1   Clinique Jouvenet, Institut de la Main, Paris, France
,
Nathalie Kerfant
2   Service de Chirurgie Orthopédique et Chirurgie Plastique, SOS mains, CHU La Cavale Blanche, Brest, France
,
Abhijeet L. Wahegaonkar
3   Hand and Microvascular Reconstructive Surgery–Hand Surgery Associates, Pune, India
4   Sancheti Institute for Orthopaedics and Rehabilitation, Pune, India
,
Andrea A. Tandara
5   Heidelberg University Hospital, Heidelberg, Germany
,
Christophe L. Mathoulin
1   Clinique Jouvenet, Institut de la Main, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2013 (online)

Abstract

Purpose The purpose of this study is to report the association of dorsal wrist capsular avulsion with scapholunate ligament instability and to evaluate the results of an arthroscopy-assisted repair.

Methods We retrospectively reviewed 10 patients with a mean age of 39.1 years suffering from chronic dorsal wrist pain. They underwent a wrist arthroscopy with an evaluation of the scapholunate ligament complex from the radiocarpal and midcarpal compartments. An avulsion of the dorsal intercarpal ligament (DICL) from the scapholunate interosseous ligament (SLIL) was visible from the radiocarpal compartment in all cases, while the SLIL was intact. The DICL tear was repaired with an arthroscopy-assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by the QuickDASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire, by the Visual Analog Scale (VAS) for pain, and by a clinical and radiological examination.

Results Preoperatively, all patients had reduced flexion and radial deviation of the affected wrist. On the lateral radiograph, 5 of the 10 patients showed an increase of the scapholunate angle (60 to 85°). The scapholunate instability was graded as Messina–European Wrist Arthroscopy Society (EWAS) II in five cases and as grade IIIB in five cases. A tear of the ulnar part of the triangular fibrocartilage complex (TFCC) was found in seven cases. At a mean followup of 16 months, the wrist range of motion (ROM), the grip strength, the QuickDASH, and the VAS of pain improved significatively. The scapholunate angle was normalized in all cases.

Discussion Isolated tears of the DICL at its insertion from the dorsal part of the SLIL can be associated with scapholunate instability in the absence of an injury to the SLIL. The diagnosis is made arthroscopically. The arthroscopic dorsal capsuloplasty is a minimally invasive technique that provides short-term satisfactory results. Further studies are needed to determine whether repair of the DICL tear could prevent secondary destabilization of the scapholunate ligament complex.

Level of evidence IV (case series) Diagnosis

 
  • References

  • 1 Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin 1997; 13 (1) 39-49
  • 2 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (2) 170-178
  • 3 Van Overstraeten L. Anatomie arthroscopique et lésions des ligaments extrinsèques. In: Camus E, Van Overstraeten L, , eds. La chirurgie ligamentaire du carpe avant l'arthrose. Montpellier, France: Sauramps Medical; 2009: 105-116
  • 4 Elsaidi GA, Ruch DS, Kuzma GR, Smith BP. Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study. Clin Orthop Relat Res 2004; 425 (425) 152-157
  • 5 Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am 2004; 29 (2) 279-288
  • 6 Mathoulin C, Dauphin N, Sallen V. Arthroscopic dorsal capsuloplasty in chronic scapholunate ligament tears: a new procedure; preliminary report. Chir Main 2011; 30 (3) 188-197
  • 7 Short WH, Werner FW, Green JK, Weiner MM, Masaoka S. The effect of sectioning the dorsal radiocarpal ligament and insertion of a pressure sensor into the radiocarpal joint on scaphoid and lunate kinematics. J Hand Surg Am 2002; 27 (1) 68-76
  • 8 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (3) 297-309
  • 9 Geissler WB. Management of scapholunate instability. In: Geissler WB, , ed. Wrist Arthroscopy. New York, NY: Springer; 2005: 86-93
  • 10 Atzei A, Rizzo A, Luchetti R, Fairplay T. Arthroscopic foveal repair of triangular fibrocartilage complex peripheral lesion with distal radioulnar joint instability. Tech Hand Up Extrem Surg 2008; 12 (4) 226-235
  • 11 Geissler WB. Traitement arthroscopique des instabilités scapholunaires. Chir Main 2006; 25 (Suppl. 01) S187-S196
  • 12 Slutsky DJ. Arthroscopic dorsal radiocarpal ligament repair. Arthroscopy 2005; 21 (12) 1486
  • 13 Adler BD, Logan PM, Janzen DL , et al. Extrinsic radiocarpal ligaments: magnetic resonance imaging of normal wrists and scapholunate dissociation. Can Assoc Radiol J 1996; 47 (6) 417-422
  • 14 Garcia-Elias M. Carpal instabilities and dislocations. In: Green DP, Hotchkiss RN, Pederson WC, , eds. Operative Hand Surgery. 4th ed. New York, NY: Churchill-Livingstone; 1999: 865-928
  • 15 Feipel V, Rooze M. The capsular ligaments of the wrist: morphology, morphometry and clinical applications. Surg Radiol Anat 1999; 21 (3) 175-180
  • 16 Theumann NH, Pfirrmann CW, Antonio GE , et al. Extrinsic carpal ligaments: normal MR arthrographic appearance in cadavers. Radiology 2003; 226 (1) 171-179
  • 17 Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg Am 1999; 24 (3) 456-468