Management of Scapholunate Ligament Pathology

Ross, Mark; Geissler, William B.; Loveridge, J.; Couzens, Greg

doi:10.1007/978-1-4614-1596-1_10

Cited by 5 publications

(8 citation statements)

References 66 publications

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“…11 Recent findings have lessened the role of the SLIL and shown that the dorsal capsulo-scapholunate septum might play a very important role in SL stability as well as a proprioceptive role over the proximal row stability. 12 13 14 15 16…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that arthroscopy is very sensitive to detect and treat ligamentous lesions. 1 4 9 11 16 17 Open ligamentous repairs or reconstructions have been described, 9 11 18 19 but these techniques result in considerable soft-tissue damage to secondary stabilizers and vascular supply 20 and lead to clinical stiffness. 21 22 Arthroscopic techniques have been described to treat SLIL lesions, for example, a simple debridement and thermal shrinkage in acute cases, 9 but they have not shown good results in chronic cases.…”

Section: Discussionmentioning

confidence: 99%

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Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears

et al. 2023

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Background Many debates are still ongoing for the management of chronic scapholunate (SL) injuries. We have proposed an arthroscopic technique of dorsal capsulodesis with good clinical results. We now propose a radiological follow-up. Purpose To determine if arthroscopic dorsal capsulodesis can improve the radiographic SL angle and maintain this correction over time. Methods From January 2020 to January 2021, we included every patient with an SL instability and sorted them according to the European Wrist Arthroscopy Society (EWAS) classification. All patients had bilateral X-rays with a measurement of the radiolunate (RL) and SL angles for both the pathologic and healthy side. We also included patients with lunotriquetral or triangular fibrocartilage complex lesions. The exclusion criteria were the presence of arthritis and persistent intraoperative SL instability after capsulodesis. An arthroscopic dorsal capsulodesis was performed in all patients as originally described by Mathoulin. The RL and SL angles were then again measured on the immediate postoperative X-ray, and then again at 3, 6, and 12 months postoperatively. The statistical analysis was done using a paired Student's t-test with 145 degrees of freedom and α = 0.05. Results We included a total of 146 patients with a 1-year follow-up. Both the RL angle and the SL angles approach the healthy side at 12 months postoperatively. The RL angle has increased from −7.23 degrees to 4.37 degrees; the difference is still statistically significative, but it is almost equal to the healthy side (5.16 degrees). The SL angle has lowered from 74.55 to 54.95; the difference is still statistically and radiologically significative (6.788 degrees) but has been lowered by 74.3%. Conclusion This study shows that this technique can normalize the dorsal intercalated segment instability (DISI) over time without the need for any pinning or invasive ligament reconstructive surgery. Level of Evidence Level IV, cohort study. Clinical Relevance Dorsal capsulodesis should be considered in all reducible SL injuries, even when DISI is present.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears

et al. 2023

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Section: Discussionmentioning

confidence: 99%

“…Described surgical management options for pSLIL injuries without significant carpal instability include arthroscopic debridement with or without pinning, capsular shrinkage, arthroscopic or OC, and open tenodesis. 38,[50][51][52] Biomechanical studies have consistently demonstrated that the dorsal SLIL is the strongest component of the SLIL. 15 Passive and active motion cadaveric sectioning studies, however, suggest that in the setting of SLIL injury, carpal malalignment occurs only when extrinsic wrist ligaments are also deficient.…”

Section: Discussionmentioning

confidence: 99%

Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options

et al. 2023

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Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group (N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group (N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group (N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group (N = 12, mean age = 43 years, range = 28–67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°–70.7°; AC = 67°–74.5°; and OC = 48.9°–63.5°), whereas it remained unchanged for the NT group (46°–45°). Grip strength also improved in all intervention groups (ES = 17.9–29.9 kg; AC = 24.0–32.2 kg; and OC = 15.8–26.6 kg), while the NT group remained unchanged (25–24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2–1.9 mm; OC = 2.5–1.8 mm) and slightly worsened in the NT group (2.5–2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications—CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III–IV studies.

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“…Klassifikation Zur Einteilung hat sich die von Geissler ([18], zitiert nach [19]) angegebene Arthroskopie-basierte Klassifikation bewährt (▶ Tab. 3).…”

Section: Verletzungen Des Sl-bandesunclassified