Concepts and Artistry in the Treatment of Scapholunate Ligament Injuries

Elzinga, Kate; Kamnerdnakta, Sirichai; Chung, Kevin C.

doi:10.1097/prs.0000000000004690

Cited by 6 publications

(2 citation statements)

References 33 publications

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“…The diagnosis and treatment of SLIL pathology is a subject of debate with substantial specialist-to-specialist variation in care. [15][16][17] This study identified that viewing diagnostic wrist arthroscopy rather than clinical findings led to a significant increase in recommendation for surgery. Even though the interpretation of SLIL pathology on arthroscopy was not reliable, viewing a video resulted in more frequent and more invasive treatment recommendations.…”

Section: Discussionmentioning

confidence: 99%

Treatment Recommendations for Suspected Scapholunate Ligament Pathology

et al. 2021

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Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology. Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed. Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight. Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology. Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs. Level of Evidence Not applicable.

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Section: Discussionmentioning

confidence: 99%

Treatment Recommendations for Suspected Scapholunate Ligament Pathology

et al. 2021

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“…2 Reconstructive strategies have mainly focused on reconstructing only the dorsal portion of the scapholunate ligament as this has been demonstrated to be its strongest component. 9 Many techniques can be found in the literature that involve the use of either soft tissue or bone grafts for scapholunate reconstruction. [10][11][12][13][14][15][16][17][18][19][20] Most newer techniques aim at reconstructing the dorsal, volar, and secondary scapholunate stabilizers.…”

Section: Ementioning

confidence: 99%

Long-Term Outcomes of Arthroscopic-Assisted Bone-Ligament-Bone Reconstruction for non-static Scapholunate Ligament Injury.

Rosa

Bertozzi

Annoscia

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the results obtained by reconstructing the scapholunate ligament with a bone–ligament–bone autograft through an arthroscope-assisted minimally invasive approach. Methods: Thirty-six patients were enrolled initially but only 31 constituted the final population study (23 male, eight female; median age, 38 years; age range, 18 to 55 years). Radiographic (posteroanterior and true lateral radiographs to assess the scapholunate gap, radiolunate, and capitolunate angles; computed tomographic scan; magnetic resonance images), functional [grip strength (Jamar test and pinch test), active range of motion], and subjective (patient-rated wrist evaluation test) outcome measurements were collected. Minimum follow-up was 50 months. Results: Grip strength and wrist mobility were significantly improved from the preoperative values and improved over time. No scapholunate synostosis or carpal bone necrosis was observed. No wrist showed any sign of arthrosis or progression towards wrist instability. Only four patients had scapholunate gap greater than 3 mm. Conclusions: The proposed technique for scapholunate reconstruction, providing a biologic reconstruction of both the volar and dorsal portion of the scapholunate ligament and avoiding extensive capsulotomy, obtained significant functional outcomes improvement that was maintained over time and prevented degenerative changes to the articular surfaces. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

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