Scapholunate Ligament Reconstruction

Abstract

Reconstruction of chronic scapholunate (SL) ligament pathology remains a significant challenge for hand surgeons. There are several unresolved issues in regard to when reconstruction should be undertaken in preference to repair. This question relates to the difficulties in defining what represents acute, subacute, and chronic SL ligament pathology. Patients and MethodsThis technique is indicated for a dynamic or reducible (intraoperatively) static SL instability where other forms of SL reconstruction may be considered. It may also offer an augmentation for acute and semi-acute repairs of the SL ligament. It has also been successfully used in acute AbstractBackground Scapholunate reconstruction poses a challenge to orthopedic surgeons. Materials and Methods Prospective cohort. Description of Technique Our technique for scapholunate (SL) reconstruction involves ligament reconstruction utilizing a portion of the flexor carpi radialis tendon rerouted via transosseous tunnels across the scaphoid, lunate, and triquetrum (scapholunotriquetral tenodesis). The tendon graft is secured with interference screw fixation into the triquetrum. The philosophy of this new technique is to reduce subluxation and maintain the relationship between scaphoid and lunate by placing a graft through the center of the SL articulation. This graft is then tensioned by passing it centrally through the lunate and triquetrum and secured using an interference screw in the triquetrum. Secondary stabilizers, including the dorsal intercarpal ligament, are then augmented by passing the graft back to the scaphoid, crossing from the triquetrum over the proximal capitate. This further reinforces the translational relationship between the scaphoid and the triquetrum and, therefore, augments stability of the SL articulation. Results We have utilized this technique successfully in over 40 patients since 2009. We report on a prospective consecutive series of 11 patients with over 12 months follow-up (range 12 to 24 months) demonstrating good early radiological and clinical outcomes. Conclusions In developing this technique, we aimed to take the best features of previously described techniques and address the perceived shortcomings of each. We believe there are several benefits of our technique. Moreover, few other techniques address as many of the aspects of chronic SL instability as our technique does.

Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation: a prospective observational study

“…The proportion of patients suffering from static SLD in this study is rather high (78%), Ross and colleagues investigated 72% static SLD and Garcia-Elias reported a 21% proportion in their cohorts regarding operative treatment options for SLD [14, 16]. Strikingly, this is not resulting in poorer outcome in the presented study despite these more challenging patient characteristics.…”

“…The recently published data by Ross et al did not report on qualitative outcome regarding patient satisfaction, hence a comparison with current results is not yet possible [16]. However, they presented good results of regained grip strength and Q-DASH post-operatively.…”

Scapholunate and perilunate injuries in the athlete

“…They believe the SLAM technique is superior to other reconstructive options because no other method has been proven to restore scaphoid extension, decrease the SL gap, and correct scaphoid pronation using a multi-planar biologic tether; in addition, there is no need for screw removal and the graft is less rigid than with a metal screw [35]. Similar to the SLAM, Ross et al proposed a new ligament reconstruction technique in which a portion of the FCR tendon is rerouted through a transosseous tunnel across the scaphoid, lunate, and triquetrum [41]. This technique is different from the SLAM in that it can also be used for lunotriquetral ligament injuries.…”

“…This technique is different from the SLAM in that it can also be used for lunotriquetral ligament injuries. Having used the technique in more the 40 patients since 2009, Ross et al reported improved quickDASH and PRWE scores, grip strength, pain, similar ROM, and a maintained SL interval on radiographs [41]. They compared their outcomes to other ligament reconstructions and determined that their clinical and radiographic outcomes were similar, if not superior.…”

“…They compared their outcomes to other ligament reconstructions and determined that their clinical and radiographic outcomes were similar, if not superior. Therefore, they concluded that the technique is effective but expressed caution because of the small number of patients studied and complexity of the procedure [41].…”