Journal List > J Korean Soc Surg Hand > v.21(2) > 1106548

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

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.

REFERENCES

1. Jones WA. Beware the sprained wrist: the incidence and diagnosis of scapholunate instability. J Bone Joint Surg Br. 1988; 70:293–7.
crossref
2. Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am. 1996; 21:170–8.
crossref
3. Ruby LK, An KN, Linscheid RL, Cooney WP 3rd, Chao EY. The effect of scapholunate ligament section on scapholunate motion. J Hand Surg Am. 1987; 12:767–71.
crossref
4. Sokolow C, Saffar P. Anatomy and histology of the scapholunate ligament. Hand Clin. 2001; 17:77–81.
crossref
5. Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am. 2007; 32:297–309.
crossref
6. Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984; 9:358–65.
crossref
7. Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am. 1996; 78:357–65.
crossref
8. Zarkadas PC, Gropper PT, White NJ, Perey BH. A survey of the surgical management of acute and chronic scapholunate instability. J Hand Surg Am. 2004; 29:848–57.
crossref
9. Beredjiklian PK, Dugas J, Gerwin M. Primary repair of the scapholunate ligament. Tech Hand Up Extrem Surg. 1998; 2:269–73.
crossref
10. Blatt G. Capsulodesis in reconstructive hand surgery: dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin. 1987; 3:81–102.
11. Szabo RM, Slater RR Jr, Palumbo CF, Gerlach T. Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results. J Hand Surg Am. 2002; 27:978–84.
crossref
12. Schweizer A, Steiger R. Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid. J Hand Surg Am. 2002; 27:674–84.
crossref
13. Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am. 1998; 23:205–15.
crossref
14. Harvey EJ, Hanel D, Knight JB, Tencer AF. Autograft replacements for the scapholunate ligament: a biomechanical comparison of hand-based autografts. J Hand Surg Am. 1999; 24:963–7.
crossref
15. Dobyns JH, Linscheid RL, Chao EY, Weber ER, Swanson GE. Traumatic instability of the wrist. Instr Course Lect. 1975; 24:182–99.
16. Brunelli GA, Brunelli GR. A new technique to correct carpal instability with scaphoid rotary subluxation: a preliminary report. J Hand Surg Am. 1995; 20:S82–5.
crossref
17. Van Den Abbeele KL, Loh YC, Stanley JK, Trail IA. Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg Br. 1998; 23:258–61.
crossref
18. Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am. 2006; 31:125–34.
crossref
19. Sousa M, Aido R, Freitas D, Trigueiros M, Lemos R, Silva C. Scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. J Hand Surg Am. 2014; 39:1512–6.
crossref

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.
jkssh-21-55f1.tif
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.
jkssh-21-55f2.tif
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
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.

TOOLS
Similar articles