Analysis of the Postoperative Outcomes of the Chronic Scapholunate Ligament Instability Managed by Various Surgical Techniques

Kee Baek Ahn; In Hyeok Rhyou; Kyung Chul Kim; Hyeong Jin Kim; Ji-Ho Lee; Seong Cheol Moon

doi:10.12790/jkssh.2016.21.2.55

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Ahn, Rhyou, Kim, Kim, Lee, and Moon: Analysis of the Postoperative Outcomes of the Chronic Scapholunate Ligament Instability Managed by Various Surgical Techniques

ORIGINAL ARTICLE

J Korean Soc Surg Hand 2016;21(2):55-62.

Published online: 11 June 2016

DOI: https://doi.org/10.12790/jkssh.2016.21.2.55

Analysis of the Postoperative Outcomes of the Chronic Scapholunate Ligament Instability Managed by Various Surgical Techniques

Kee Baek Ahn, In Hyeok Rhyou, Kyung Chul Kim, Hyeong Jin Kim, Ji-Ho Lee, Seong Cheol Moon

Department of Orthopaedic Surgery, Upper Extremity and Microsurgery Center, Pohang Semyeong Christianity Hospital, Pohang, Korea

Correspondence to: In Hyeok Rhyou, Department of Orthopaedic Surgery, Pohang Semyeong Christianity Hospital, 35 Posco-daero 367beon-gil, Nam-gu, Pohang 37814, Korea, TEL: +82-054-289-1765, FAX: +82-054-289-1766, E-mail: osdrrih@gmail.com

Received 30 March 201612 May 2016 Accepted 17 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose:

To investigate mid-term clinical outcomes of various methods of scapholunate reconstruction for chronic scapholunate instability.

Methods:

We retrospectively reviewed 11 patients diagnosed as chronic scapholunate instability, from 2005 to 2013 and followed up for more than one year after surgery. 7 patients were treated with Garcia technique of triple ligament reconstruction, 2, bone-ligamemt-bone repair, and 2, dorsal capsulodesis. Mean age was 42 years (range, 23-61 years). The right side was involved in 6 patients, and the left in 5. The follow-up period averaged 42 months (range, 13-125 months). The postoperative functional outcomes were assessed with Modified Mayo wrist score (MMWS), disability of the arm, shoulder and hand (DASH) score and range of motion. The postoperative radiologic results were analyzed with the change of scapholunate angle and distance.

Results:

The mean MMWS score improved from 65 preoperatively to 77 postoperatively (p=0.072). The mean DASH score improved from 29.4 (range, 18.3-43.3) preoperatively to 12.7 (range, 0-38.3) postoperatively (p=0.003). The dorsiflexion increased from 67° to 78°, the volar flexion decreased from 51° to 45°, the supination increased from 69° to 88°, and the pronation increased from 62° to 66°. The SL angle changed from 55° preoperatively to 51° postoperatively, the mean SL distance changed from 3.4 mm preoperatively to 1.7 mm postoperatively.

Conclusion:

The chronic scapholunate instability is amenable to various techniques and postoperative functional outcomes improved satisfactory.

Keywords: Chronic scapholunate instability, Ligament reconstruction

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Fig. 1.

(A) Preoperative radiograph shows an anteroposterior view. (B-E) Photographs showing the operative procedure of scapholunate ligament reconstruction using half-strip of flexor carpi radialis tendon. (F, G) Radiographs taken at 12 months after operation.

Fig. 2.

(A) Preoperative radiographs show normal. (B) Arthroscopic finding through midcarpal joint showing a step-off of scapholunate joint. (C, D) Photographs showing the operative procedure of bone-ligament-bone technique. (E) Radiographs taken at 36 months after operation.

Table 1.

Patient demographics and results

Patient	Age (yr)	Sex	Follow-up (mo)	Stage	Procedure	Changes of ROM (°)								Change of MMWS		Change of DASH		SL diastasis (mm)		SL angle (°)
						Dorsiflexion		Volarflexion		Supination		Pronation		Pre	Pop	Pre	Pop	Pre	Pop	Pre	Pop
						Pre	Pop	Pre	Pop	Pre	Pop	Pre	Pop	Pre	Pop	Pre	Pop	Pre	Pop	Pre	Pop
1	25	Male	15	Static	3LT	80	80	40	40	80	80	60	60	75	90	41.6	4.1	3.7	2.4	64	62
2	61	Female	19	Static	3LT	80	80	50	50	90	90	70	70	70	90	20	5.8	5.3	1.4	65	34
3	45	Male	20	Static	3LT	75	70	40	30	90	90	65	70	60	95	24.1	2.5	3.3	1.5	80	65
4	51	Male	24	Static	3LT	35	80	45	50	50	90	65	70	50	35	43.3	25.8	5.2	2.3	57	52
5	30	Female	13	Dynamic	3LT	70	85	50	30	60	90	50	70	65	70	35	25.8	2.2	1.3	55	58
6	56	Male	78	Static	3LT	70	80	50	50	70	75	60	50	70	90	30	12.5	4.3	1.4	69	54
7	25	Male	19	Static	3LT	80	85	85	70	90	90	75	75	75	95	18.3	12.5	5.0	1.2	45	48
8	53	Male	46	Dynamic	BRB	60	75	50	40	50	90	70	60	70	90	21.6	0	1.7	1.2	58	54
9	46	Male	35	Dynamic	BRB	70	65	40	35	70	90	50	60	50	25	40	38.3	2.7	1.4	30	43
10	52	Male	63	Dynamic	Capsulodesis	60	85	50	50	60	90	60	70	60	80	20	13.3	2.3	2.3	48	44
11	23	Female	125	Dynamic	Capsulodesis	70	85	50	50	60	90	50	70	80	95	30	0	2.4	2.3	39	44

ROM, range of motion; MMWS, modified Mayo wrist score; DASH, disabilities of arm, shoulder and hand; SL, scapholunate: Pre, preoperative; Pop, postoperative; 3LT, triple ligament reconstruction; BRB, bone-ligament-bone.

Table 2.

Preoperative and postoperative clinical outcomes

Outcomes	Preoperative	Postoperative	p-value
Dorsiflexion	67	78	0.027
Vorlarflexion	51	45	0.005
Supination	69	88	0.017
Pronation	62	66	0.201
DASH	29.4	12.7	0.003
MMWS	65.9	77.7	0.072

DASH, disabilities of arm, shoulder and hand; MMWS, modified Mayo wrist score.

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