Cable-augmented, Quad Ligament Tenodesis Scapholunate Reconstruction

Abstract

Eight patients underwent scapholunate reconstruction using tensionable suture anchors. Adapted from a modified Brunelli technique, the anchors provide a fixed cable that reduces the scapholunate diastasis and maintains reduction during the healing phase. The flexor carpi radialis tendon graft is advanced through the scaphoid and stabilizes the volar scaphotrapezial ligament, dorsal scapholunate ligament, dorsal intercarpal ligament, and dorsal radiocarpal ligament. The ligament-sparing approach is closed using an ulnar advancement capsulodesis that further reinforces the dorsal intercarpal and dorsal radiocarpal ligament. Good clinical results were obtained. Measured on a visual analog scale (0 to 10), the average pain score improved from 5.8 to 2.1, average patient satisfaction was 7.6, average extension was 56 degrees (91% of contralateral side), flexion was 44 degrees (70% of contralateral side), and grip was strength 41 kg (95% of contralateral side). Radiographic parameters were less favorable. The average scapholunate angle was 71 degrees, radiolunate angle 16 degrees, and scapholunate interval 3.0 mm. The cable-augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages over previously published techniques, but long-term follow-up is required.

“Locked” Scapholunate Instability Diagnosed with 4D Computed Tomography Scan

“…An SL reconstruction using flexor carpi radialis (FCR) tendon graft was performed with the Quad tenodesis technique. 7,8 This involves use of hemi FCR graft to reconstruct the volar scaphotrapezial ligament (vSTTL), dorsal scapholunate ligament (DSLL), dorsal intercarpal ligament (DICL), and dorsal radiocarpal ligament (DRCL). It also involves use of tensionable sutures to reduce and stabilize SL interval (►Fig.…”

“…15 In this case, we were able to successfully reduce and reconstruct the SL interval, using tensionable suture anchors and the Quad tenodesis. 7,8 With the extended delay from the initial injury, we were concerned that we may not be able to reduce the SLI.…”

The history of suture anchors in orthopaedic surgery

“…Bain (senior author) and colleagues have described the repair of collateral ligaments in the unstable elbow using tensionable anchors (Lee et al, 2012). They have also documented scapholunate repair using a modified Brunelli technique, and report that if the suture from one tensionable anchor is passed into another then 'anchors in series' can be created for both a ligament fixation and diastasis reduction (Bain et al, 2013).…”

Chronic Scapholunate Ligament Injury

“…8). [58][59][60] Mayo wrist scores were 9 and 83, respectively. Total wrist motion and grip strength were maintained, averaging 85% of the contralateral side.…”