PDF
ePub
Citation
Print
초록
The incidence of ligament injuries of the wrist has increased due to sports activities. However, diagnosis and management of these injuries are sometimes difficult because of the anatomic complexity and variable injury patterns. The scapholunate ligament is both a key ligament in the stability of the carpus and one of the most frequently injured. The presentation of scapholunate instability often includes a vague injury history and pain with grip, wrist extension, and sport or labor. To properly diagnose and manage these conditions, thorough understanding of the wrist anatomy and physical and radiologic examination is mandatory. This article will briefly discuss the wrist joint anatomy and biomechanics, and review the diagnosis and surgical management of the scapholunate ligament injury.
REFERENCES
1.Wolfe SW., Neu C., Crisco JJ. In vivo scaphoid, lunate, and capitate kinematics in flexion and in extension. J Hand Surg Am. 2000. 25:860–9.
2.Seradge H., Owens W., Seradge E. The effect of intercarpal joint motion on wrist motion: are there key joints? An in vitro study. Orthopedics. 1995. 18:727–32.
3.Kitay A., Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am. 2012. 37:2175–96.
4.Rajan PV., Day CS. Scapholunate ligament insufficiency. J Hand Surg Am. 2015. 40:583–5.
5.Watson HK., Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am. 1984. 9:358–65.
6.O’Meeghan CJ., Stuart W., Mamo V., Stanley JK., Trail IA. The natural history of an untreated isolated scapholunate interosseus ligament injury. J Hand Surg Br. 2003. 28:307–10.
7.Mayfield JK., Johnson RP., Kilcoyne RF. The ligaments of the human wrist and their functional significance. Anat Rec. 1976. 186:417–28.
8.Mayfield JK. Wrist ligamentous anatomy and patho-genesis of carpal instability. Orthop Clin North Am. 1984. 15:209–16.
9.Buijze GA., Lozano-Calderon SA., Strackee SD., Blankev-oort L., Jupiter JB. Osseous and ligamentous scaphoid anatomy: part I. A systematic literature review highlight-ing controversies. J Hand Surg Am. 2011. 36:1926–35.
10.Andersson JK. Treatment of scapholunate ligament injury: current concepts. EFORT Open Rev. 2017. 2:382–93.
11.Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin. 1997. 13:63–82.
12.Walsh JJ., Berger RA., Cooney WP. Current status of scapholunate interosseous ligament injuries. J Am Acad Orthop Surg. 2002. 10:32–42.
13.Watson HK., Ashmead D 4th., Makhlouf MV. Examination of the scaphoid. J Hand Surg. 1988. 13:657–60.
14.Linn MR., Mann FA., Gilula LA. Imaging the symptomatic wrist. Orthop Clin North Am. 1990. 21:515–43.
15.Linscheid RL., Dobyns JH., Beabout JW., Bryan RS. Trau-matic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 1972. 54:1612–32.
16.Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. AJR Am J Roent-genol. 2009. 192:80–5.
17.Rohman EM., Agel J., Putnam MD., Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am. 2014. 39:2020–6.
18.Cerezal L., de Dios Berná-Mestre J., Canga A, et al. MR and CT arthrography of the wrist. Semin Musculoskelet Radiol. 2012. 16:27–41.
19.Geissler WB. Arthroscopic management of scapholunate instability. J Wrist Surg. 2013. 2:129–35.
20.Messina JC., Van Overstraeten L., Luchetti R., Fairplay T., Mathoulin CL. The EWAS classification of scapholunate tears: an anatomical arthroscopic study. J Wrist Surg. 2013. 2:105–9.
21.Andersson JK., Garcia-Elias M. Dorsal scapholunate ligament injury: a classification of clinical forms. J Hand Surg Eur Vol. 2013. 38:165–9.
22.Linscheid RL., Dobyns JH., Beabout JW., Bryan RS. Trau-matic instability of the wrist: diagnosis, classification, and pathomechanics. J Bone Joint Surg Am. 2002. 84-A:142.
23.Slutsky DJ. Current innovations in wrist arthroscopy. J Hand Surg Am. 2012. 37:1932–41.
24.Danoff JR., Karl JW., Birman MV., Rosenwasser MP. The use of thermal shrinkage for scapholunate instability. Hand Clin. 2011. 27:309–17.
25.Lee JI., Nha KW., Lee GY., Kim BH., Kim JW., Park JW. Long-term outcomes of arthroscopic debridement and thermal shrinkage for isolated partial intercarpal ligament tears. Orthopedics. 2012. 35:e1204–9.
26.Arnoczky SP., Aksan A. Thermal modification of connective tissues: basic science considerations and clinical im-plications. Instr Course Lect. 2001. 50:3–11.
27.Hayashi K., Markel MD. Thermal capsulorrhaphy treatment of shoulder instability: basic science. Clin Orthop Relat Res. 2001. 59–72.
28.Wallace AL., Hollinshead RM., Frank CB. Creep behavior of a rabbit model of ligament laxity after electrothermal shrinkage in vivo. Am J Sports Med. 2002. 30:98–102.
29.Owens BD., Stickles BJ., Busconi BD. Radiofrequency energy: applications and basic science. Am J Orthop (Belle Mead NJ). 2003. 32:117–20. discussion 120-1.
30.Lopez MJ., Hayashi K., Vanderby R Jr., Thabit G 3rd., Fan-ton GS., Markel MD. Effects of monopolar radiofrequency energy on ovine joint capsular mechanical properties. Clin Orthop Relat Res. 2000. 286–97.
31.Hecht P., Hayashi K., Lu Y, et al. Monopolar radiofrequency energy effects on joint capsular tissue: potential treatment for joint instability. An in vivo mechanical, mor-phological, and biochemical study using an ovine model. Am J Sports Med. 1999. 27:761–71.
32.Naseef GS 3rd., Foster TE., Trauner K., Solhpour S., Ander-son RR., Zarins B. The thermal properties of bovine joint capsule. The basic science of laser- and radiofrequency-in-duced capsular shrinkage. Am J Sports Med. 1997. 25:670–4.
33.Slutsky DJ., Nagle DJ. Wrist arthroscopy: current concepts. J Hand Surg Am. 2008. 33:1228–44.
34.Hirsh L., Sodha S., Bozentka D., Monaghan B., Steinberg D., Beredjiklian PK. Arthroscopic electrothermal collagen shrinkage for symptomatic laxity of the scapholunate interosseous ligament. J Hand Surg Br. 2005. 30:643–7.
35.Megerle K., Bertel D., Germann G., Lehnhardt M., Hellmich S. Long-term results of dorsal intercarpal ligament capsulodesis for the treatment of chronic scapholunate instability. J Bone Joint Surg Br. 2012. 94:1660–5.
36.Moran SL., Ford KS., Wulf CA., Cooney WP. Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg Am. 2006. 31:1438–46.
37.Soong M., Merrell GA., Ortmann F 4th., Weiss AP. Long-term results of bone-retinaculum-bone autograft for scapholunate instability. J Hand Surg Am. 2013. 38:504–8.
38.Seradge H., Baer C., Dalsimer D., Seradge A., Shafi RA., Parker W. Treatment of dynamic scaphoid instability. J Trauma. 2004. 56:1253–60.
39.Brunelli GA., Brunelli GA. Carpal instability with scapholunate dissociation treated using the flexor carpi radialis and scaphoid-trapezoid ligament repair: foundations, technique and results of preliminary series. Rev Chir Orthop Reparatrice Appar Mot. 2003. 89:152–7.
40.Vance RM., Gelberman RH., Evans EF. Scaphocapitate fractures. Patterns of dislocation, mechanisms of injury, and preliminary results of treatment. J Bone Joint Surg Am. 1980. 62:271–6.
41.Garcia-Elias M. The non-dissociative clunking wrist: a personal view. J Hand Surg Eur Vol. 2008. 33:698–711.
42.De Smet L., Goeminne S., Degreef I. Failures of the three-ligament tenodesis for chronic static scapholunate dissociation are due to insufficient reduction. Acta Orthop Belg. 2011. 77:595–7.
43.Luchetti R., Atzei A., Cozzolino R., Fairplay T. Current role of open reconstruction of the scapholunate ligament. J Wrist Surg. 2013. 2:116–25.
44.Ross M., Peters SE., Couzens GB. Scapho-luno-triquetral tenodesis. Day CS, Shin AY, editors. Advances in scapholunate ligament treatment. Chicago, IL: American Society for Surgery of the Hand;2013.
45.Corella F., Del Cerro M., Ocampos M., Larrainzar-Garijo R. Arthroscopic ligamentoplasty of the dorsal and volar portions of the scapholunate ligament. J Hand Surg Am. 2013. 38:2466–77.
46.Garcia-Elias M., Lluch A., Ferreres A., Papini-Zorli I., Rahimtoola ZO. Treatment of radiocarpal degenerative osteoarthritis by radioscapholunate arthrodesis and distal scaphoidectomy. J Hand Surg Am. 2005. 30:8–15.
47.Chee KG., Chin AY., Chew EM., Garcia-Elias M. Antipronation spiral tenodesis--a surgical technique for the treatment of perilunate instability. J Hand Surg Am. 2012. 37:2611–8.
Fig.1.
Radiologic findings of the scapholunate dissociation. Wide scapholunate gap, cortical ring sign in the posteroante-rior view and dorsal intercalated segmental instability pattern in the lateral view can be seen.
Fig.2.
Arthroscopic thermal shrinkage. (A) 42-year-old female patient's left wrist radiocarpal arthroscopy image shows focal dorsal synovitis. (B) Same patient's midcarpal arthroscopy image shows Geissler grade II scapholunate instability (Sca: scaphoid, Lu: lunate). (C) Same patient's midcarpal arthroscopy image shows thermal shrinkage on the volar scaphoilunate interosseous ligament and volar carpal ligament.
Fig.3.
Modified three-ligament tenodesis using flexor carpi radialis (FCR) tendon. (A) Visible gap between scaphoid and lunate, (B) harvesting the half-slip of FCR tendon, (C) tendon passed through scaphoid bone tunnel, (D) tendon sutured to the lunate and dorsal intercarpal ligament.
Fig.4.
Antipronation spiral tenodesis using Palmaris longus free tendon graft. (A) Pre-operative X-ray shows static scapholunate dissociation and dorsal intercalated segmental instability defor-mity. (B) The dorsal ligamentous linkage between scaphoid and triquetrum is reestablished by pal-maris longus (PL) graft. (C) Distal stump of PL graft is fixing at scaphoid bone tunnel with bio-composite interference screw. (D) Postoperative X-ray shows reduction of scapholunate dissociation.
Table1.
Arthroscopic EWAS staging of scapholunate interosseous ligament ruptures
XML Download