J Wrist Surg 2013; 02(02): 105-109
DOI: 10.1055/s-0033-1345265
Special Focus: The Schapholunate Ligament Complex
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The EWAS Classification of Scapholunate Tears: An Anatomical Arthroscopic Study

Jane C. Messina
1   Hand Surgery Unit, Gaetano Pini Orthopaedic Institute, Milano, Italy
,
Luc Van Overstraeten
2   Hand and Foot Surgery Unit, Tournai, Belgium
,
Riccardo Luchetti
3   Rimini Hand Surgery and Rehabilitation Center, Rimini, Italy
,
Tracy Fairplay
4   Fairplay Rehabilitation Office, Bologna, Italy
,
Christophe L. Mathoulin
5   Clinique Jouvenet, Institut de la Main, Paris, France
› Author Affiliations
Further Information

Publication History

Publication Date:
21 May 2013 (online)

Abstract

Treatment of scapho-lunate (SL) injuries is still a challenge for the surgeon, especially in chronic cases. The aim of the study isto experimentally cut, specific portions of scapholunate ligament and extrinsic ligaments and check their corresponding arthroscopic finding in order to understand the pathogenesis and develop a new classification system which is an evolution of the present arthroscopic classifications.

Materials and Methods Thirteen cadaver wrists were studied under arthroscopy. Different portions of the scapho-lunate ligament were subsequently sectioned. In group A the sectioning sequence was: anterior SLIOL, RSC, LRL, SLIOL's proximal and posterior, DIC, DRC ligament and ST ligaments (8 cases). In group B it was: SLIOL's posterior and proximal, DIC, SLIOL's anterior, LRL, RSCL, DRC, ST ligaments (5 cases). The anatomo-pathological findings after each sectioning were correlated to the classification system proposed (Table 1).

Results In group A, stage 3A was obtained when SL ligament's volar and intermediate portion and/ or SC/LRL ligaments were sectioned. A stage 3C was obtained when section of posterior SLIOL was sectioned as well. A stage IV when the DIC was also sectioned. In group B a stage 3B was obtained by cutting intermediate, posterior portion of the SLIOL ligament and DIC. A stage 3C was obtained when the anterior part of the SLIOL was also sectioned. In all cases, sectioning of the SLIOL lead to a stage 3C only if associated with sectioning of at least one of the extrinsic stabilizers (DIC or SC/LRL). Sectioning of DIC and SC ligament, in addition to SLIOL led to an arthroscopic stage IV. When ST, DRC and TH ligaments were also sectioned significant radiological signs appeared (stage V).

Conclusions This study helps us to understand the anatomo-pathological scapho-lunate lesions in their different stages of partial lesions. Commonly called scapho-lunate lesions are complex, involving also extrinsic ligaments.

 
  • References

  • 1 Mayfield JK. Patterns of injury to carpal ligaments. A spectrum. Clin Orthop Relat Res 1984; 187 (187) 36-42
  • 2 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (8) 1612-1632
  • 3 Taleisnik J. The ligaments of the wrist. J Hand Surg Am 1976; 1 (2) 110-118
  • 4 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
  • 5 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
  • 6 Geissler WB. Arthroscopically assisted reduction of intra-articular fractures of the distal radius. Hand Clin 1995; 11 (1) 19-29
  • 7 Dautel G, Goudot B, Merle M. Arthroscopic diagnosis of scapho-lunate instability in the absence of X-ray abnormalities. J Hand Surg [Br] 1993; 18 (2) 213-218
  • 8 Dautel G, Merle M. Dynamic arthroscopic tests for the diagnosis of scaphoid-lunar instabilities [in French]. Ann Hand Surg 1993; 12 (3) 206-209
  • 9 Dreant N, Dautel G. Development of an arthroscopic severity score for scapholunate instability [in French]. Chir Main 2003; 22 (2) 90-94
  • 10 Lindau T, Arner M, Hagberg L. Intraarticular lesions in distal fractures of the radius in young adults. A descriptive arthroscopic study in 50 patients. J Hand Surg [Br] 1997; 22 (5) 638-643
  • 11 Slutsky DJ. Clinical applications of volar portals in wrist arthroscopy. Tech Hand Up Extrem Surg 2004; 8 (4) 229-238
  • 12 Slutsky DJ. Arthroscopic dorsal radiocarpal ligament repair. Arthroscopy 2005; 21 (12) 1486
  • 13 Abe Y, Doi K, Hattori Y, Ikeda K, Dhawan V. A benefit of the volar approach for wrist arthroscopy. Arthroscopy 2003; 19 (4) 440-445
  • 14 del Piñal F, Studer A, Thams C, Glasberg A. An all-inside technique for arthroscopic suturing of the volar scapholunate ligament. J Hand Surg Am 2011; 36 (12) 2044-2046
  • 15 Marcuzzi A, Leti Acciaro A, Caserta G, Landi A. Ligamentous reconstruction of scapholunate dislocation through a double dorsal and palmar approach. J Hand Surg [Br] 2006; 31 (4) 445-449
  • 16 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (6) 991-1002
  • 17 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am 2005; 30 (1) 24-34
  • 18 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
  • 19 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
  • 20 Viegas SF. Midcarpal arthroscopy: anatomy and portals. Hand Clin 1994; 10 (4) 577-587
  • 21 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
  • 22 Meade TD, Schneider LH, Cherry K. Radiographic analysis of selective ligament sectioning at the carpal scaphoid: a cadaver study. J Hand Surg Am 1990; 15 (6) 855-862
  • 23 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
  • 24 Messina JC, Dreant N, Luchetti R, Lindau T, Mathoulin C. Nuova classificazione delle lesioni del legamento scafolunato. Rivista di Chirurgia della Mano 2009; (46) 156-157
  • 25 Messina JC, Dreant N, Luchetti R, Lindau T, Mathoulin C. Scapho-lunate tears: a new arthroscopic classification. Chirurgie de la Main 2009; 28 (6) 339-344
  • 26 Van Overstraeten L. Arthroscopic anatomy and lesions of the extrinsic ligaments. In: Camus E, Van Overstraeten L, , eds. Carpal Ligament Surgery: Before Arthritis. France: Springer-Verlag; 2013: 119-131
  • 27 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (2) 170-178
  • 28 Luchetti R, Zorli IP, Atzei A, Fairplay T. Dorsal intercarpal ligament capsulodesis for predynamic and dynamic scapholunate instability. J Hand Surg Eur Vol 2010; 35 (1) 32-37
  • 29 Moran SL, Cooney WP, Berger RA, Strickland J. Capsulodesis for the treatment of chronic scapholunate instability. J Hand Surg Am 2005; 30 (1) 16-23
  • 30 Mathoulin CL, Dauphin N, Wahegaonkar AL. Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears. Hand Clin 2011; 27 (4) 563-572 , xi
  • 31 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
  • 32 Slutsky DJ. Current innovations in wrist arthroscopy. J Hand Surg Am 2012; 37 (9) 1932-1941