Treatment Recommendations for Suspected Scapholunate Ligament Pathology

Abstract

Background The diagnosis and treatment of scapholunate interosseous ligament (SLIL) pathology is debated and notably variable. This study assessed the influence of diagnostic arthroscopy on treatment recommendations and the interobserver reliability of the arthroscopic classification of SLIL pathology. Methods The influence of diagnostic arthroscopy on treatment recommendations and the reliability of the arthroscopic classification of SLIL pathology were tested in a survey-based experiment. Seventy-seven surgeons evaluated 16 scenarios of people with wrist pain with variation in symptoms, scaphoid shift, time of symptom onset, and MRI appearance of the SLIL. Participants were randomized to view or not to view diagnostic wrist arthroscopy. Factors associated with recommendation for repair, capsulodesis, or tenodesis were analyzed. Results Viewing arthroscopic videos was associated with both offering surgery and a more reconstructive option. Other factors independently associated with recommendation for surgery included greater pain intensity and activity intolerance, women surgeons, an asymmetric scaphoid shift, and a recent onset of symptoms. The interobserver reliability of SLIL classification was slight. Conclusions Diagnostic arthroscopy leads to more surgery, and more invasive surgery, in spite of unreliable assessment of pathology. Clinical Relevance This points to the need to measure the potential benefits and harms of diagnostic wrist arthroscopy among people with wrist pain and no clear diagnosis on interview, examination, and radiographs. Level of Evidence Not applicable.

Comparing Patient-Reported Outcomes on Three-Ligament Tenodesis Between Partial and Complete Scapholunate Ligament Injuries: A Cohort Study

“…Moreover, wrist arthroscopy was performed by multiple surgeons with varying arthroscopy expertise. Surgeons may debate the subjectivity of arthroscopic distinction between Geissler 2 and 3 tears, 7,8 whereas Geissler 4 tears generally are evident on arthroscopy. 36 Since we put Geissler 2 and 3 SLIL tears in the same study group, we do not expect this to have influenced the results.…”

“…Although the classification has moderate intra-and interobserver reliability and does not identify lesions to the secondary stabilizers of the wrist, it remains the gold standard. 7,8 It generally is accepted that the difference between a Geisler type 2 or 3, a stretched ligament, or a partial tear of the ligament, which can be a normal physiologic situation, and a type 4 where there is a complete tear of the scapholunate (SL) ligament and instability of the secondary stabilizers, can be made during arthroscopy. 9,10 If the SLIL ligament is not repaired shortly after trauma (within a 4 to 6 weeks from injury), this repair is no longer possible and a reconstruction of the SLIL ligament must be performed.…”