17.6 Arthroscopic Thermal Shrinkage for Scapholunate Ligament Injuries

Abstract

Based on modified Geissler's classification we had 16 stage II, 36 stage III and 12 stage IV scapholunate lesions. Results: Our average follow up period is 34 months (range 12-62 months). Mobility was normal in 57 cases. Pain disappeared in 59 cases, was moderate in three cases and disabling in two cases. Grip strength increased in comparison to pre-operative levels but in seven cases it never came back to the level of the normal contralateral side. We had one radial nerve lesion, two minor Sudeck's dystrophy and one radio-scaphoid arthritis. Mayo-wrist score showed 89% excellent or good results. Discussion: Prolonged immobilization of the scapholunate space permits satisfying and long-lasting healing in acute cases. The use of wrist arthroscopy facilitates the quality of the reduction and wiring and limits the surgical exposure with a negligible aesthetic price to pay.Background: The use of arthroscopic thermal shrinkage with radiofrequency (RF) for the treatment of scapholunate (SL) ligament injuries is a recent technique and the real effectiveness is undetermined. Aim: To determine the effectiveness for the treatment of symptomatic SL ligament injuries. Study design: Clinical prospective randomized study. Methods: From 2001 to 2004, 120 patients presenting with chronic dorsoradial wrist pain unresponsive to conservative treatment for a mean period of 10 weeks were included in this study. Forty patients with Geissler grades I and II SL injuries were treated with shrinkage (group A) and 40 patients with the same lesion (group B) were treated with arthroscopic debridement. Twenty patients with Geissler grades III SL injuries (group C) were treated with shrinkage plus pinning with K-wire and twenty patients with the same lesion (group D) were treated with arthroscopic debridement plus pinning with K-wire. The shrinkage of the SL ligament was performed with a 2.3 mm monopolar RF probe excluding the most palmar aspect of the ligament and extending to the entire dorsal section of the ligament and to the dorsal capsula. Clinical outcome was evaluated at 3, 6, 12, 18 month and final evaluation was 28 months average after the treatment. Instruments for outcome evaluation included pre and postoperative use of modified wrist-scoring system of Mayo Clinic and DASH questionnaire.