Scapholunate instability: improved detection with semi-automated kinematic CT analysis during stress maneuvers

W, Abou Arab; Rauch, Aymeric; Mb, Chawki; Dap, F.; Dautel, G.; Blum, Alain; Pa, Gondim Teixeira

doi:10.1007/s00330-018-5430-2

Cited by 28 publications

(18 citation statements)

References 24 publications

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“…Third, the amplitude of the RUD movement was not standardized, and it varied from one patient to another. In our study, the mean RUD amplitude was similar between the three groups, and this parameter did not influence the diagnostic performance of 4-DCT in prior studies (Abou Arab et al., 2018; Rauch et al., 2018). Fourth, implementation of this new imaging modality requires training of the medical staff and also teaching the patient how to perform the movement correctly without moving the forearm.…”

Section: Discussionsupporting

confidence: 67%

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Assessment of scapholunate instability with dynamic computed tomography

Athlani¹,

Rouizi

Granero³

et al. 2019

J Hand Surg Eur Vol

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We performed a prospective study to evaluate the values of dynamic four-dimensional computed tomography in assessing suspected chronic scapholunate instability. Forty patients were evaluated with radiographs, arthrography, and four-dimensional computed tomography. On plain radiographs and computed tomography, we found 16 patients with definite scapholunate instability, five with questionable scapholunate instability, and 19 with absence of scapholunate instability. We used four-dimensional computed tomography to evaluate the size of the scapholunate gap during radioulnar deviation. The mean and maximal values of the gap size were lowest in the patients with absence of scapholunate instability and highest in those with definite scapholunate instability. When comparing the scapholunate gap sizes of the patients with absent and questionable scapholunate instability, the range of the gap sizes was significantly higher in the patients with questionable scapholunate instability. We conclude that four-dimensional computed tomography aids assessment of chronic scapholunate instability, which allows the differentiation between patients without and those with definite or questionable scapholunate instability. Level of evidence: II

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Section: Discussionsupporting

confidence: 67%

“…Kakar et al. (2016) and Abou Arab et al. (2018) stated that the RUD movement was better at detecting SL ligament lesions than clenched fist movements.…”

Section: Discussionmentioning

confidence: 99%

Assessment of scapholunate instability with dynamic computed tomography

Athlani¹,

Rouizi

Granero³

et al. 2019

J Hand Surg Eur Vol

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“…19 Thus, it might be possible to identify and treat patients with an early stage of SLI characterized by a partial SLL tears associated with an extrinsic ligament injury. [20][21][22] As for the type of movement used during 4DCT, Abou Arab et al 12 and Rauch et al 13 stated that the RUD movement was better at detecting SLL lesions than clenched fist movements. According to these authors, analyzing the carpus during RUD movements has better diagnostic performance and superior reproducibility than during clenched fist movements.…”

Section: Discussionmentioning

confidence: 99%

“…6 Dynamic imaging can provide information about carpal anatomy and alignment by analyzing the carpus and its joint spaces during various wrist movements. 11 Abou Arab et al 12 and Rauch et al 13 described the use of dynamic four-dimensional CT (4DCT) to analyze the carpus during radioulnar deviation (RUD). 4DCT allowed a dynamic and quantitative analysis of the LCA with a correlation to scapholunate ligament (SLL) status on CT arthrogram.…”

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confidence: 99%

Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability

Athlani

Granero²,

Rouizi

et al. 2021

J Wrist Surg

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Background In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI). Methods Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation. Results The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCAmean. The LCAmax values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCAcv (7% vs. 12%, p = 0.02) and LCArange (18 vs. 27 degrees, p = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCAcv (p = 0.03) and LCArange (p = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCAcv and LCArange threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively. Conclusion In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings. Level of evidence This is a Level III study.

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“…From a diagnostic viewpoint, dynamic modelling of the scapholunate complex based on four-dimensional CT scan has completely revolutionized our understanding of wrist biomechanics. It is now established that changes in gap measurements during movement is more important than the static scapholunate gap (Abou Arab et al., 2018; Kakar et al., 2016). In addition, the greater the variation in the scapholunate gap, the less stable the scapholunate joint, and the increased likelihood that the wrist would progress to scapholunate instability.…”

Section: Existing Challenges and The Futurementioning

confidence: 99%

Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques

Mathoulin¹,

Merlini²,

Taleb

2020

J Hand Surg Eur Vol

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The management of scapholunate injuries and dissociation remains debatable. Traditional methods of fixation had centred around open procedures, but advances in wrist arthroscopic techniques has redefined both major anatomical findings and operative approaches. This article challenges two main existing dogmas: first, the anatomy of the scapholunate ligament and second, the management of these injuries. For the first, we propose that scapholunate stability is in fact maintained by a whole anatomic complex, consisting of well-defined capsuloligamentous structures and extrinsic ligaments, and that the scapholunate ligament itself probably has a limited role. For the second, we challenge the notion that scapholunate injuries often require open procedures and propose that mini-invasive arthroscopic dorsal repair of the scapholunate complex is an efficient technique and sufficient for achieving long-term stability.

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Scapholunate instability: improved detection with semi-automated kinematic CT analysis during stress maneuvers

Cited by 28 publications

References 24 publications

Assessment of scapholunate instability with dynamic computed tomography

Assessment of scapholunate instability with dynamic computed tomography

Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability

Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques

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