Arthroscopic Volar Capsuloligamentous Repair

Abstract

).The palmar aspect of the capsuloligamentous complex of the wrist is relatively inaccessible to open surgery. When the palmar aspect of the scapholunate (SL) or the palmar aspect of the lunotriquetral (LT) ligament is torn, it is either repaired through an open surgical approach or left unrepaired. I have previously published an all-arthroscopic technique for suture repair of the palmar aspect of the SL ligament (►Fig. 1a-c) 1 that can also be used to close rents in the space of Poirier and to repair the palmar aspect of the lunotriquetral ligament. IndicationsThe procedure can be used to repair any of the palmar structures of the capsuloligamentous complex. In perilunate dislocation and perilunate fracture dislocation, I have used a similar technique to repair the palmar portion of the scapholunate ligament, to close the space of Poirier, and to repair the palmar portion of the lunotriquetral ligament. ContraindicationsThis technique cannot be used if there is no remaining viable ligament that is amenable to suturing. Surgical TechniqueIn my experience, palpation of bony prominences is crucial in determining the proper entry sites of the Tuohy needle and Kirschner wires (K-wires). For this reason, I prefer using a dry technique for wrist arthroscopy so that fluid distension will not distort the anatomy. 2,3 An understanding of the all-inside technique and its possible variations is required. 4,5 The ligament stumps are first debrided with a full-radius resector and the adjacent bony surfaces refreshed with a burr inserted through the midcarpal ulnar (MCU) and midcarpal radial (MCR) portals. The scope is then positioned in the MCU portal to have an unimpeded view of the palmar SL space, while the MCR is left free for instrumentation. A 22 gauge needle inserted immediately ulnar to the flexor carpi radialis (FCR), 1 cm proximal to the distal wrist crease, will penetrate the midcarpal joint in the vicinity of the SL space. As this may require several attempts before the position is satisfactory, an intramuscular needle, which has a smaller bore than the Tuohy, may first be used to minimize the local insult. Next, the Tuohy needle is inserted following the same path.A (colored) 2-0 polydioxanone (PDS) suture is then threaded through the Tuohy needle, retrieved from the Keywords ► wrist arthroscopy ► scapholunate ligament repair ► space of Poirier ► all-inside technique AbstractBackground The palmar aspect of the capsuloligamentous complex of the wrist is relatively inaccessible to surgery through an open approach. An all-inside arthroscopic suturing technique is presented that allows suturing of the palmar scapholunate or lunotriquetral ligaments or plication of the space of Poirier. Methods Eight palmar scapholunate ligaments and four major tears of the volar capsuloligamentous complex of the wrist due to a perilunate dislocation have been repaired. Results No complications occurred during or after the procedure. It was not possible to separate the effects of the palmar repair from the disparate treatment of the ...

The Role of Dynamic (4D) CT in the Detection of Scapholunate Ligament Injury

“…Finally, 4DCT may allow for a more selective surgical treatment directed at the specific location of the tear. 26,27 4DCT allowed noninvasive characterization of where the ligament injury likely occurred. The injuries were validated intraoperatively demonstrating the ability of 4DCT to accurately diagnose SL injury, which were not present on standard radiographs or MRI.…”

Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results

“…Finally, the secondary dorsal stabilizers are also affected by this surgical approach. 19 There are reports of dorsal and palmar arthroscopic capsuloligamentous suturing techniques, 20,21 but none of these cases deal with acute primary repair of the injured/detached ligament, and therefore do not reproduce the repair like it could be done in open surgery.…”

Arthroscopic dorsal ligamento capsulodesis results in Geissler grade 2 and 3 scapholunate interosseous ligament injuries

“…[22][23][24] Son yıllarda artroskopi ile skafolunat yırtıkları için dorsal ve palmar kapsüloligamentöz tamir teknikleri tanımlanmıştır. [8][9][10]25] Mathoulin ve ark. [9] kronik Geissler 2, 3. ve 4. derece skafolunat bağ lezyonlarında artroskopik dorsal kapsüloligamentöz tekniği ile tedavi etmişler ve bu yöntemin ilk sonuç-larını yayınlamışlardır.…”