RSS-Feed abonnieren
DOI: 10.1055/s-0033-1341582
Arthroscopic Dorsal Capsulo-Ligamentous Repair in the Treatment of Chronic Scapho-Lunate Ligament Tears
Publikationsverlauf
Publikationsdatum:
21. Mai 2013 (online)
![](https://www.thieme-connect.de/media/jws/201302/lookinside/thumbnails/10.1055-s-0033-1341582-1.jpg)
Abstract
Introduction Scapholunate ligament injuries usually result due to a fall on the outstretched hand leading to scapholunate instability. The natural history of untreated scapholunate instability remains controversial and usually results in late arthritic changes- the so-called “SLAC” wrist. The advent of wrist arthroscopy helps in early diagnosis and treatment of these serious injuries. In selected cases with reducible scapholunate instability (Garcia-Elias stages 2, 3 and 4) we propose a new “all arthroscopic dorsal capsulo- ligamentous repair” with the added advantage of early rehabilitation and prevention of post-operative stiffness.
Material and Methods We report the results of our series of 57 consecutive patients suffering from chronic wrist pain refractory to conservative measures. All patients underwent a thorough clinical examination in addition to a standard set of radiographs and MRI exam; and they were treated by an all-arthroscopic dorsal capsulo-ligamentous repair under loco-regional anesthesia on an ambulatory basis. All patients were available for follow-up at regular intervals during the post-operative period. At follow-up, the wrist ROM in all directions, the grip strength, DASH questionnaire and pain relief based on the VAS were recorded for both- the operated and contra-lateral sides.
Results There were 34 males & 23 females with a mean age of 38.72 ± 11.33 years (range 17–63 years). The dominant side was involved in 52 cases. The mean time since injury was 9.42 ± 6.33 months (range 3–24 months) and the mean follow-up was 30.74 ± 7.05 months (range 18–43 months). The mean range of motion improved in all directions. The mean difference between the post- and pre-operative extension was 14.03° (SEM = 1.27°; p < 0.001); while the mean difference between the post-and pre-operative flexion was 11.14° (SEM = 1.3°; p < 0.0001) with flexion and radial deviation reaching 84.3% and 95.72% respectively of the unaffected wrist. The mean difference for the VAS score was -5.46 (SEM = 0.19; p < 0.0001). The mean post-operative grip strength of the affected side was 38.42 ± 10.27 kg (range 20–60 kg) as compared with mean pre-operative grip strength of 24.07 ± 10.51 kg (range 8–40 kg) (p < 0.0001). The mean post-operative grip strength of the operated side was 93.4% of the unaffected side. The DISI was corrected in all cases on post-operative radiographs. The mean difference between the post-and pre-operative SL angles was −8.95° (SEM = 1.28°; p < 0.0001). The mean post-operative DASH score was 8.3 ± 7.82 as compared with mean pre-operative DASH score of 46.04 ± 16.57 (p < 0.0001). There was a negative co-relation between the overall DASH score and the post-operative correction of the DISI deformity with a lower DASH score associated with increasing SL angles.
Discussion The dorsal portion of the scapholunate ligament is critical for the stability scapholunate articulation, largely due to its attachment to the dorsal capsule. We have recently conducted a multi-centric anatomical study with international collaboration demonstrating the critical importance of this dorsal scapholunate complex. The all arthroscopic capsulo-ligamentous repair technique provides reliable results in addition to avoiding postoperative stiffness. The overall results at a mean follow-up period of more than 2 years in our series of young, active patients appear to be encouraging.
-
References
- 1 Kalainov DM, Cohen MS. Treatment of traumatic scapholunate dissociation. J Hand Surg Am 2009; 34 (7) 1317-1319
- 2 Mathoulin Ch, Dauphin N. Sallen v. Capsulodèse arthroscopique dorsale dans les lésions chroniques du ligament scapho-lunaire. Chir. Main 2009; 28 (6) 398
- 3 Geissler WB, Haley T. Arthroscopy management of scapholu- nate instability. Atlas of Hand Clinics 6: 253-274 , 2001
- 4 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 (1) 125-134
- 5 Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 1999; 24 (5) 953-962
- 6 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (3) 358-365
- 7 Pilný J, Kubes J, Hoza P, Sprláková A, Hart R. [Consequennce of nontreatment scapholunate instability of the wrist]. Rozhl Chir 2006; 85 (12) 637-640
- 8 Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin 1987; 3 (1) 81-102
- 9 Busse F, Felderhoff J, Krimmer H, Lanz U. [Scapholunate dissociation: treatment by dorsal capsulodesis]. Handchir Mikrochir Plast Chir 2002; 34 (3) 173-181
- 10 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 (5) 848-857
- 11 Deshmukh SC, Givissis P, Belloso D, Stanley JK, Trail IA. Blatt's capsulodesis for chronic scapholunate dissociation. J Hand Surg [Br] 1999; 24 (2) 215-220
- 12 Moran SL, Ford KS, Wulf CA, Cooney WP. Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg Am 2006; 31 (9) 1438-1446
- 13 Links AC, Chin SH, Waitayawinyu T, Trumble TE. Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg Am 2008; 33 (6) 850-856
- 14 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (2) 205-215
- 15 Slater Jr RR, Szabo RM, Bay BK, Laubach J. Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model. J Hand Surg Am 1999; 24 (2) 232-239
- 16 Szabo RM, Slater Jr RR, Palumbo CF, Gerlach T. Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results. J Hand Surg Am 2002; 27 (6) 978-984
- 17 Wintman BI, Gelberman RH, Katz JN. Dynamic scapholunate instability: results of operative treatment with dorsal capsulodesis. J Hand Surg Am 1995; 20 (6) 971-979
- 18 Gajendran VK, Peterson B, Slater Jr RR, Szabo RM. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation. J Hand Surg Am 2007; 32 (9) 1323-1333
- 19 Brunelli F, Spalvieri C, Bremner-Smith A, Papalia I, Pivato G. [Dynamic correction of static scapholunate instability using an active tendon transfer of extensor brevi carpi radialis: preliminary report]. Chir Main 2004; 23 (5) 249-253
- 20 Chabas JF, Gay A, Valenti D, Guinard D, Legre R. Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients. J Hand Surg Am 2008; 33 (9) 1469-1477
- 21 Talwalkar SC, Edwards AT, Hayton MJ, Stilwell JH, Trail IA, Stanley JK. Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability. J Hand Surg [Br] 2006; 31 (1) 110-117
- 22 De Smet L, Van Hoonacker P. Treatment of chronic static scapholunate dissociation with the modified Brunelli technique: preliminary results. Acta Orthop Belg 2007; 73 (2) 188-191
- 23 Harvey EJ, Berger RA, Osterman AL, Fernandez DL, Weiss AP. Bone-tissue-bone repairs for scapholunate dissociation. J Hand Surg Am 2007; 32 (2) 256-264
- 24 Almquist EE, Bach AW, Sack JT, Fuhs SE, Newman DM. Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation. J Hand Surg Am 1991; 16 (2) 322-327
- 25 Bleuler P, Shafighi M, Donati OF, Gurunluoglu R, Constantinescu MA. Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis longus tenodesis. J Hand Surg Am 2008; 33 (2) 281-284
- 26 Ogunro O. Dynamic stabilization of chronic scapholunate dissociation with palmaris longus transfer: a new technique. Tech Hand Up Extrem Surg 2007; 11 (4) 241-245
- 27 Rosenwasser MP, Miyasajsa KC, Strauch RJ. The RASL procedure: reduction and association of the scaphoid and lunate using the Herbert screw. Tech Hand Up Extrem Surg 1997; 1 (4) 263-272
- 28 Siegel JM, Ruby LK. A critical look at intercarpal arthrodesis: review of the literature. J Hand Surg Am 1996; 21 (4) 717-723
- 29 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 (8) 1380-1386