Extensor Carpi Radialis Longus Tenodesis Using a Biotenodesis Screw for Treatment of Symptomatic Geissler 2 Scapholunate Dissociation

Stone, Andrew; Shahid, Zuhaib; Agarwal, Sujit; Sarkhel, Tanaya

doi:10.1055/s-0039-1683943

Cited by 1 publication

(1 citation statement)

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“…His technique resembles the dorsal component of Dynadesis; however, he did not reinforce the passive volar scaphoid stabilizers. Recently, Stone 43 reported a partial ECRL tendon transfer to the scaphoid but did not provide case numbers or follow-up data. He also refers to the procedure as a tenodesis and performs it in the same setting as the arthroscopy when some patients improve from arthroscopic debridement alone.…”

Section: Discussionmentioning

confidence: 99%

Dynadesis for Treatment of Dynamic Scaphoid Instability with 20-Year Results

Parker¹,

Seradge²,

Steppe³

et al. 2021

J Wrist Surg

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Background Even though the scapholunate interosseous ligament is the most common wrist ligament injury, its treatment remains a challenge for hand surgeons. We report on a surgical treatment (Dynadesis) for dynamic scaphoid instability (DSI) with a 20-year follow-up period. Description of Technique Dynadesis utilizes antagonist forearm muscles in order to synergistically provide dynamic stabilization to the scaphoid when the wrist is loaded. It is a tendon-to-tendon transfer with the following two components: 1) Dorsal—The extensor carpi radialis longus (ECRL) is passed through a hole in the reduced, distal scaphoid, providing the scaphoid with an independent extension force. 2) Volar—A dynamic checkrein is created by tension-locking the ECRL tendon around the flexor carpi radialis (FCR) tendon. The portion of the FCR distal to the scaphoid tethers and tightens with contracture of the ECRL and FCR muscles. Patients and Methods Twenty patients (21 wrists) were treated with Dynadesis and reevaluated 20 years later (range: 20–27 years). Results Average grip strength improved by 8 kg. The average wrist flexion-extension arc decreased by 3°. Wrist X-rays showed no radiocarpal arthritis. On the Mayo wrist score, 81% reported excellent to good results (average: 89). Pain levels improved by 90%, with 76% of patients reporting no pain. All patients (100%) were satisfied with their results and would recommend the procedure. Conclusions Dynadesis is specifically designed for the treatment of DSI. It avoids the eventual complication of osteoarthritis and does not sacrifice wrist motion. A predictable and satisfactory long-term result is obtainable with correct patient selection based on clinical staging and arthroscopic findings.

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Section: Discussionmentioning

confidence: 99%