Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Abstract

The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months.Paired t-tests were used preoperatively, one month after pin removal, and at final followup to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.

Equivalent Clinical Outcomes Following Favored Treatments of Chronic Scapholunate Ligament Tear

“…Deshmukh et al reported mean wrist extension/flexion of 38°/40°after performing 44 capsulodesis procedures for chronic SL instability, but was limited by a disproportionate number of worker compensation claims and prolonged injury-to-treatment time averaging 52 months [8]. Similar results were reported by Yang et al after review of 12 wrists with chronic stable SL instability undergoing capsulodesis [26]. The latter study additionally noted almost immediate radiographic deterioration of the SL gap within 1 month, which is consistent with the poorer radiographic findings for capsulodesis in our present review.…”

Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction

“…Long-term studies of patients undergoing SL repair or reconstruction after chronic SLIL injury have shown a pattern of radiographic deterioration with time. [6][7][8][9][10] We were unable to identify any studies that correlated radiographic findings and pain/functional outcome scores. 7 Finding an association between these parameters would be important for guiding preoperative planning and establishing surgical goals.…”

“…Several reports demonstrate radiographic, objective, and patient-reported outcomes (PROs) after SLIL reconstruction surgeries. [6][7][8][9][10] While these studies generally demonstrate improvement in functional outcomes and pain, the striking feature in their results is long-term radiographic deterioration. It is also notable that no correlation has been demonstrated between radiographic measurements and PROs.…”