Anatomical anterior and posterior reconstruction for scapholunate dissociation: preliminary outcome in ten patients

Abstract

This study reviews the efficacy of a reconstruction to address scapholunate dissociation using an anterior and posterior approach with a hybrid synthetic tape/tendon weave between the trapezium, scaphoid, lunate and radius: an anatomical front and back (ANAFAB) repair. This repair is a compilation of the components of a number of previously reported repair techniques, and based on published kinematic evidence. It aims to restore the anatomical mechanical constraints on both anterior and posterior aspects of the carpus. Patients were immobilized in a cast for 6 weeks, but no stabilizing wires were used. Ten patients have undergone the reconstruction and were assessed at a minimum 24-month follow-up. They achieved excellent realignment of the carpus, a postoperative median scapholunate gap of 3 mm and a recovery of more than 75% of grip strength and range of motion. No patient required secondary surgery or treatment related to the carpal stabilization. Level of evidence: IV

The application of computer-based quantitative analysis to explain carpal biomechanics

“…Recent studies have provided additional support for the important role of the LRL and dorsal ligamentous connections (Pérez et al., 2019). A detailed explanation is beyond the summary in this article and is covered by other publications (Sandow, 2020b; Sandow and Fisher, 2020).…”

“…K wires were not used, but the wrist was immobilized in a cast for 6 weeks. Modified from illustration in Sandow and Fisher (2020) with permission from the Journal of Hand Surgery (European Volume). scapholunate connection and the connection of the lunate to the DIC.…”

“…In cases of scapholunate diastasis and collapse of the central column, the application of a logic-based reconstructive volar and dorsal – anatomical front and back (ANAFAB) – surgical solution (Figure 4) has restored carpal function in a series of patients (Sandow and Fisher, 2020). This constitutes an initial proof of concept.…”

Current Concepts in Scapholunate Instability Without Arthritic Changes

“…While the conceptually appealing author has only described a single case with an 08-year follow-up. ANAFAB-Anatomic front and back repair aim to restore the scapho-lunate interosseous ligament and potential volar carpal ligaments that may have been injured [ 69 ]. The technique is based on a distally based FCR strip augmented with synthetic tape, drawn across a bone tunnel in scaphoid from volar to dorsal and then dorsal to volar across a bone tunnel in the lunate.…”

Scapholunate instability: why are the surgical outcomes still so far from ideal?

“…We avoid the more destructive open techniques and intraosseous tendon grafts in the carpus. If there is volar or ulnar translocation of the proximal carpal row, other options may need to be considered (Del Pinal, 2013; Sandow and Fisher, 2020).…”