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Borrel F, Gras M, Arnaout A, Mathoulin C, Merlini L. Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears. J Wrist Surg 2023; 12:433-438. [PMID: 37841361 PMCID: PMC10569849 DOI: 10.1055/s-0043-1764159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/24/2023] [Indexed: 10/17/2023]
Abstract
Background Many debates are still ongoing for the management of chronic scapholunate (SL) injuries. We have proposed an arthroscopic technique of dorsal capsulodesis with good clinical results. We now propose a radiological follow-up. Purpose To determine if arthroscopic dorsal capsulodesis can improve the radiographic SL angle and maintain this correction over time. Methods From January 2020 to January 2021, we included every patient with an SL instability and sorted them according to the European Wrist Arthroscopy Society (EWAS) classification. All patients had bilateral X-rays with a measurement of the radiolunate (RL) and SL angles for both the pathologic and healthy side. We also included patients with lunotriquetral or triangular fibrocartilage complex lesions. The exclusion criteria were the presence of arthritis and persistent intraoperative SL instability after capsulodesis. An arthroscopic dorsal capsulodesis was performed in all patients as originally described by Mathoulin. The RL and SL angles were then again measured on the immediate postoperative X-ray, and then again at 3, 6, and 12 months postoperatively. The statistical analysis was done using a paired Student's t -test with 145 degrees of freedom and α = 0.05. Results We included a total of 146 patients with a 1-year follow-up. Both the RL angle and the SL angles approach the healthy side at 12 months postoperatively. The RL angle has increased from -7.23 degrees to 4.37 degrees; the difference is still statistically significative, but it is almost equal to the healthy side (5.16 degrees). The SL angle has lowered from 74.55 to 54.95; the difference is still statistically and radiologically significative (6.788 degrees) but has been lowered by 74.3%. Conclusion This study shows that this technique can normalize the dorsal intercalated segment instability (DISI) over time without the need for any pinning or invasive ligament reconstructive surgery. Level of Evidence Level IV, cohort study. Clinical Relevance Dorsal capsulodesis should be considered in all reducible SL injuries, even when DISI is present.
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Chung SR, Nah JH, Chin AYH. Arthroscopy-Assisted Scapholunate Reconstruction With Internal Brace Augmentation. Arthrosc Tech 2023; 12:e1161-e1169. [PMID: 37533927 PMCID: PMC10391263 DOI: 10.1016/j.eats.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/09/2023] [Indexed: 08/04/2023] Open
Abstract
Various surgical techniques exist to repair or reconstruct complete scapholunate (SL) interosseous ligament tears, including capsulodesis, static or dynamic tenodesis, ligament reconstruction with tendon graft, bone-retinaculum-bone reconstruction, and the reduction and association of the scaphoid and lunate (RASL) procedure. The choice of surgical technique depends on arthroscopic assessment using the Geissler classification and European Wrist Arthroscopy Society staging of SL injury. This article describes arthroscopy-assisted extracapsular SL reconstruction using free tendon graft and internal brace augmentation for the treatment of unrepairable complete SL interosseous ligament tears.
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Affiliation(s)
- Sze Ryn Chung
- Address correspondence to Sze Ryn Chung, M.B.B.Ch.B.A.O.(Hons), M.R.C.S.(Edin), M.M.E.D.(Surg), F.A.M.S.(Hand), Department of Hand and Reconstructive Microsurgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore.
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Rush MN, Salas C, Mottishaw L, Fountain D, Mercer D. Additive Manufacturing: The Next Generation of Scapholunate Ligament Reconstruction. J Wrist Surg 2021; 10:492-501. [PMID: 34881104 PMCID: PMC8635827 DOI: 10.1055/s-0041-1729993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Background Ligament reconstruction, as a surgical method used to stabilize joints, requires significant strength and tissue anchoring to restore function. Historically, reconstructive materials have been fraught with problems from an inability to withstand normal physiological loads to difficulties in fabricating the complex organization structure of native tissue at the ligament-to-bone interface. In combination, these factors have prevented the successful realization of nonautograft reconstruction. Methods A review of recent improvements in additive manufacturing techniques and biomaterials highlight possible options for ligament replacement. Description of Technique In combination, three dimensional-printing and electrospinning have begun to provide for nonautograft options that can meet the physiological load and architectures of native tissues; however, a combination of manufacturing methods is needed to allow for bone-ligament enthesis. Hybrid biofabrication of bone-ligament tissue scaffolds, through the simultaneous deposition of disparate materials, offer significant advantages over fused manufacturing methods which lack efficient integration between bone and ligament materials. Results In this review, we discuss the important chemical and biological properties of ligament enthesis and describe recent advancements in additive manufacturing to meet mechanical and biological requirements for a successful bone-ligament-bone interface. Conclusions With continued advancement of additive manufacturing technologies and improved biomaterial properties, tissue engineered bone-ligament scaffolds may soon enter the clinical realm.
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Affiliation(s)
- Matthew N. Rush
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Christina Salas
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico
- Department of Mechanical Engineering, The University of New Mexico, Albuquerque, New Mexico
| | - Lorraine Mottishaw
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico
| | - Damian Fountain
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Department of Biochemistry and Molecular Biology, The University of New Mexico, Albuquerque, New Mexico
| | - Deana Mercer
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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Abstract
Scapholunate ligament injuries are common and can lead to a predictable pattern of arthritis (scaphoid lunate advanced collapse wrist) if unrecognized or untreated. This article describes the relevant anatomy, biomechanics, and classification system, and provides an up-to-date literature-based review of treatment options, including acute repair and various reconstruction techniques. It also helps guide surgeons in making decisions regarding a systematic treatment algorithm for these injuries.
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Lui H, Bindra R, Baldwin J, Ivanovski S, Vaquette C. Additively Manufactured Multiphasic Bone-Ligament-Bone Scaffold for Scapholunate Interosseous Ligament Reconstruction. Adv Healthc Mater 2019; 8:e1900133. [PMID: 31112356 DOI: 10.1002/adhm.201900133] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/20/2019] [Indexed: 02/02/2023]
Abstract
The scapholunate interosseous ligament (SLIL) is a frequently torn wrist ligament, and current surgical options for SLIL tears are suboptimal. This research aims to develop a novel multiphasic bone-ligament-bone scaffold (BLB) with a porous interface using 3D-printing and cell sheet technology for the reconstruction of the dorsal scapholunate interosseous ligament. The BLB comprises two bone compartments bridged by aligned polycaprolactone fibers mimicking the architecture of the native tissue. Mechanical testing of the BLBs shows their ability to withstand physiological forces. Combination of the BLB with human bone marrow mesenchymal stem cell sheet demonstrates that the harvesting did not compromise cell viability, while allowing homogeneous distribution in the ligament compartment. The BLBs are loaded with cell sheets and bone morphogenetic protein-2 in the ligament and bone compartment respectively prior to ectopic implantation into athymic rats. The histology demonstrates rapid tissue infiltration, high vascularization, and more importantly the maintenance of the compartmentalization as bone formation remains localized to the bone compartment despite the porous interface. The cells in the ligament compartment become preferentially aligned, and this proof-of-concept study demonstrates that the BLB can provide sufficient compartmentalization and fiber guiding properties necessary for the regeneration of the dorsal SLIL.
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Affiliation(s)
- Hayman Lui
- School of Medicine, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD, 4215, Australia
| | - Randy Bindra
- School of Medicine, Griffith University, Parklands Drive, Southport, Gold Coast Campus, QLD, 4215, Australia
| | - Jeremy Baldwin
- Centre in Regenerative Medicine Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, 4059, Australia
| | - Saso Ivanovski
- School of Dentistry, the University of Queensland, Herston, 4006, Queensland, Australia
| | - Cedryck Vaquette
- Centre in Regenerative Medicine Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, 4059, Australia
- School of Dentistry, the University of Queensland, Herston, 4006, Queensland, Australia
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Biomechanical Properties of First Dorsal Extensor Compartment Regarding Adequacy as a Bone-Ligament-Bone Graft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1397. [PMID: 28831343 PMCID: PMC5548566 DOI: 10.1097/gox.0000000000001397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
Bone-ligament-bone grafts for reconstruction of the scapholunate ligament are a valuable tool to prevent disease progression to carpal collapse. Locally available grafts do not require an additional donor site. The first extensor compartment was evaluated biomechanically regarding its possible use as an autograft. METHODS Twelve native fresh-frozen, human cadaver specimens were tested by applying axial tension in a Zwick Roell machine. Load to failure, transplant elongation, and bony avulsion were recorded. The load to failure was quantitated in newtons (N) and the displacement in length (millimeters). Parameters were set at distinct points as start of tension, 1 mm stretch and 1.5 mm dissociation, failure and complete tear, and were evaluated under magnified visual control. Although actual failure occurred at higher tension, functional failure was defined at a stretch of 1.5 mm. RESULTS Mean load at 1 mm elongation was 44.1 ± 28 N and at 1.5 mm elongation 57.5 ± 42 N. Failure occurred at 111 ± 83.1 N. No avulsion of the bony insertion was observed. Half the transplants failed in the central part of the ligament, while the rest failed near the insertion but not at the insertion itself. Analysis of tension strength displayed a wide range from 3.8 to 83.7 N/mm at a mean of 33.4 ± 28.4 N/mm. CONCLUSIONS The biomechanical tensile properties of the first dorsal extensor compartment are similar to those of the dorsal part of the scapholunate ligament. A transplant with a larger bone stock and a longer ligament may display an advantage, as insertion is possible in the dorsal, easily accessible part of the carpal bones rather than in the arête-like region adjacent to the insertion of the scapholunate ligament. In this study, 1.5 mm lengthening of the bone-ligament-bone transplant was defined as clinical failure, as such elongation will cause severe gapping and is considered as failure of the transplant.
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Morrell NT, Moyer A, Quinlan N, Shafritz AB. Scapholunate and perilunate injuries in the athlete. Curr Rev Musculoskelet Med 2017; 10:45-52. [PMID: 28101827 DOI: 10.1007/s12178-017-9383-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF THE REVIEW Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. RECENT FINDINGS Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.
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Affiliation(s)
- Nathan T Morrell
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA
| | - Amanda Moyer
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA
| | - Noah Quinlan
- University of Vermont College of Medicine, The University of Vermont Medical Center, Burlington, VT, USA
| | - Adam B Shafritz
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA.
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