Chronic Scapholunate Interosseous Ligament Disruption: A Systematic Review and Meta-Analysis of Surgical Treatments

Abstract

Comparing preoperative and postoperative radiographic measurements, tenodesis reconstruction demonstrated significantly improved SLG and SLA relative to capsulodesis. Interpreted in the context of the limitations, existing data demonstrates some benefit of tenodesis reconstruction.

Management of chronic scapholunate ligament injury

“…However, both groups exhibited a similar number of patients being able to return to work at their latest follow up (87% for tenodesis v/s 86% for capsulodesis). 36 On evaluating pre-operative and latest follow up radial deviation, ulnar deviation and wrist ROM, no significant difference was found between the two groups. However, there was significant improvement in Grip strength, in tenodesis patients, by 16.8% on the contralateral hand (P < .001) and by 11.1% on the contralateral hand for capsulodesis patients (P ¼ .2).…”

“…Thus, tenodesis also had a significantly improved SLG. 36 On comparing the clinical outcomes, it was noted that tenodesis demonstrated significant improvement in VAS 3.4 (P < .001) and DASH scores 27.3 (P < .01) point improvement. On the other hand, Capsulodesis demonstrated a reduction in VAS of 3.2 points (P ¼ .5) and DASH of 20.2 points (P ¼ .7).…”

“…Thus, there was significant SLA improvement in tenodesis compared to capsulodesis (P ¼ .01). 36 SLG was reported in thirteen studies for tenodesis reconstruction and 10 studies for capsulodesis reconstruction. SLG between preoperative and last follow up had a SMD of 1.1 (CI, 0.6 to 1.55, P < .001) in tenodesis reconstruction, and 0.13 (CI, À0.36 to 0.59, P ¼ .6) for capsulodesis reconstruction.…”

“…However, there was significant improvement in Grip strength, in tenodesis patients, by 16.8% on the contralateral hand (P < .001) and by 11.1% on the contralateral hand for capsulodesis patients (P ¼ .2). 36 Daly et al compared complications amongst studies that published them, and reported infection rates of 3% and 5% in tenodesis and capsulodesis respectively. They noted that 6% of tenodesis patients required a second surgery as opposed to 4% of capsulodesis patients.…”

Arthroscopic Scapholunate Synthetic Ligamentoplasty

“…1 There is a general consensus that SLL tears after 3 months make primary healing 2 through degeneration of ligament stumps impossible and require one to perform a ligamentoplasty. Many open techniques have been described to restore the stability of the scapholunar pair, but they generate a constant 3 tightening of the wrist caused by the extrinsic capsular contraction caused by capsulotomy. 4,5 These open procedures impose an approach that may damage the secondary stabilizers of the scapholunar pair, especially the dorsal capsuloligamentous scapholunate septum (DCSS), which would play the role of a secondary stabilizer of the scapholunar pair.…”