1
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Wu M, Ilyas A. Comparison of Outcomes of Scapholunate Ligament Reconstruction Techniques. J Wrist Surg 2023; 12:558-568. [PMID: 38213567 PMCID: PMC10781577 DOI: 10.1055/s-0042-1757442] [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: 01/07/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
Introduction Injury to the scapholunate interosseous ligament (SLIL) is a common cause of carpal instability, yet surgical management of chronic SLIL disruption remains challenging with no optimal technique identified. Purpose The purpose of this meta-analysis was to comparatively review the available evidence of clinical, radiographic, and patient-reported outcome measures among popular techniques of SLIL reconstruction (capsulodesis, tenodesis, and bone-tissue-bone graft) to better guide management of SLIL injuries. Methods A total of 1,172 patients from 42 included studies were assessed. Standardized data extraction and analysis were performed. The mean of postoperative outcome assessments with standard deviation was used to calculate pooled standardized mean difference with 95% confidence interval. Results Visual Analog Scale (VAS) score for postoperative pain was lowest in bone-tissue-bone patients at 0.9 ( p = 0.0360). Bone-tissue-bone patients had the highest percentage of "excellent" functional outcomes at 64.5% ( p < 0.0001). Disabilities of the Arm, Shoulder, and Hand (DASH)/QuickDASH score was best in bone-tissue-bone patients at 9.7 ( p < 0.0001). Patient-Rated Wrist Evaluation (PRWE) score was best in tenodesis patients at 37.8 ( p = 0.0255). There were no statistically significant differences in grip strength, range of motion, or radiographic outcomes among the techniques. Conclusion Existing data demonstrate some benefit of bone-tissue-bone reconstruction over capsulodesis and tenodesis in pain reduction and functional improvement of the injured wrist. No statistically significant differences among radiographic outcomes could be ascertained, possibly attributable to the heterogeneity of procedures. This review provides an updated reference and highlights the need for multicenter trials with longer term follow-up and more standardized outcome measures.
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Affiliation(s)
- Meagan Wu
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif Ilyas
- Division of Hand and Upper Extremity Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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2
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Langdell HC, Zhang GX, Pidgeon TS, Ruch DS, Klifto CS, Mithani SK. Management of Complex Hand and Wrist Ligament Injuries. Hand Clin 2023; 39:367-377. [PMID: 37453764 DOI: 10.1016/j.hcl.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Ligamentous injuries in the hand and wrist are often underdiagnosed and can present with significant functional limitations if there is untimely recognition of injury. Adequate repair or reconstruction is critical in restoring joint stability and mobility. The purpose of this review is to provide an overview of the metacarpophalangeal joint, scapholunate interosseous ligament (SLIL), and non-SLIL carpal ligament anatomy, diagnosis, imaging, treatment consideration and options, as well as surgical techniques encompassing repair, reconstruction, and fusion.
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Affiliation(s)
- Hannah C Langdell
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Gloria X Zhang
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Tyler S Pidgeon
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - David S Ruch
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Suhail K Mithani
- Division of Plastic and Reconstructive Surgery, Duke University Medical Center, Durham, NC, USA; Department of Orthopedic Surgery, Duke University Medical Center, Durham, NC, USA.
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3
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Haerle M, Schmelzer-Schmied N, Lampert FM. Arthroscopic Capsulodesis for the Treatment of Dynamic Scapholunate Dissociations. Tech Hand Up Extrem Surg 2023; 27:95-99. [PMID: 36382512 DOI: 10.1097/bth.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of scapholunate dissociations remains a significant challenge. Open approaches suffer from a disadvantageous further impairment of the stabilizing local structures. The minimally invasive arthroscopic technique described provides reliable stability of the scapholunate interosseous ligament complex in dynamic lesions. The anatomic key structure is the dorsal capsuloligamentous scapholunate septum, which provides a mechanical connection between the scaphoid, lunate, and dorsal capsule of the wrist. Arthroscopic capsuloplasty aims to tighten and stabilize this complex structure in long term. This approach preserves the adjacent structures, namely the secondary wrist stabilizers and their neuromuscular feedback loops. With a certain degree of experience in wrist arthroscopy, the technique is reliably adaptable and reproducible.
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Affiliation(s)
- Max Haerle
- Clinic for Hand and Plastic Surgery, Orthopedic Clinic Markgroeningen, Markgröningen
| | | | - Florian M Lampert
- Clinic for Hand and Plastic Surgery, Orthopedic Clinic Markgroeningen, Markgröningen
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Freiburg, Germany
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Amarasooriya M, Jerome TJ, Tourret L. Current Concepts in Scapholunate Instability Without Arthritic Changes. Indian J Orthop 2023; 57:515-526. [PMID: 37006727 PMCID: PMC10050294 DOI: 10.1007/s43465-023-00839-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/29/2023] [Indexed: 04/04/2023]
Abstract
Scapholunate instability (SLI) is the most common carpal instability described. SLI leads to a degenerative arthritic pattern known as scapholunate advanced collapse (SLAC). Diagnosis of SLI can be challenging in pre-dynamic and dynamic stages. CT arthrogram, MR arthrogram and dynamic fluoroscopy are helpful in diagnosis while arthroscopy remains the gold standard. SLI is a multi-ligament injury, which involves not only the scapholunate interosseous ligament (SLIL) but also the extrinsic carpal ligaments. Hence, it is better described as an injury compromising the 'dorsal scapholunate(dSLL) complex'. A repair can be attempted for acute SLI presenting within 6 weeks of injury. Reconstruction is the mainstay of treatment for chronic SLI without degenerative changes. Multiple repair techniques have been described which include capsulodesis and tenodesis procedures. The clinical outcomes of the techniques have improved over the years. However, a common problem of all these techniques is the lack of long-term data on the outcomes and deteriorating radiological parameters over time. SLI staging is an important factor to be considered in choosing the reconstruction techniques for a better outcome. Currently, there is a trend towards more biological and less invasive techniques. Regardless of the technique, it is important to preserve the nerve supply of the dorsal capsuloligamentous structures of the wrist. Arthroscopic techniques being minimally invasive have the advantage of less collateral damage to the capsuloligamentous structures. Rehabilitation involves a team approach where a protected dart thrower's motion is allowed after a period of immobilization. Strengthening SL-friendly muscles and inhibiting SL-unfriendly muscles is a key principle in rehabilitation.
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Affiliation(s)
- Melanie Amarasooriya
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre and Flinders University, Bedford Park, South Australia 5042 Australia
- Orthopedic Surgeon, Ministry of Health, Colombo, Sri Lanka
| | - Terrence Jose Jerome
- Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre , Trichy, India
| | - Lisa Tourret
- Hand and Upper Limb Surgeon, Brighton and Sussex University Hospitals, NHS Trust, Brighton, UK
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5
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Imada AO, Eldredge J, Wells L, Moneim MS. Review of surgical treatment for chronic scapholunate ligament reconstruction: a long-term study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:787-793. [PMID: 35608691 DOI: 10.1007/s00590-022-03294-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 05/09/2022] [Indexed: 12/21/2022]
Abstract
PURPOSE Scapholunate dissociation (SLD) is a common entity encountered by hand surgeons. While multiple methods for surgical treatment exist, there is little agreement on the best surgical techniques to treat chronic, static SLD. Our study's goal was to assess the long-term (greater than five years), clinical and radiologic outcomes of the currently recommended treatment options for chronic, static SLD. METHODS We performed a review of the literature to assess outcomes after surgical treatment of chronic, static SLD with long-term follow-up of greater than five years. RESULTS We found only six studies that encompassed the modified Brunelli tenodesis, capsulodesis, scapholunate arthrodesis, and bone-ligament-bone graft using the modified Cuenod procedure. All were level of evidence IV. Many patients went back to some form of work. Tenodesis showed less development of arthritis and greater improvement in scapholunate gap, while capsulodesis showed greater postoperative flexion and extension. Of note, study size varied with 67 combined patients in the capsulodesis studies and 30 patients in the tenodesis studies. CONCLUSION There was no clear superiority of one procedure over the others. More long-term data are needed to identify the best surgical treatment of chronic, static SLD.
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Affiliation(s)
- Allicia O Imada
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, 87121, USA.
| | - Jonathan Eldredge
- Health Science Library and Informatics Center, The University of New Mexico, Albuquerque, NM, USA
| | - Laurie Wells
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, 87121, USA
| | - Moheb S Moneim
- Department of Orthopaedics & Rehabilitation, The University of New Mexico, Albuquerque, NM, 87121, USA
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6
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Dittman LE, Kakar S. CMC Mimickers: Differential Diagnosis and Work-Up for Radial-Sided Wrist Pain. Hand Clin 2022; 38:149-160. [PMID: 35465933 DOI: 10.1016/j.hcl.2022.01.001] [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] [Indexed: 02/02/2023]
Abstract
In patients with radial-sided wrist pain, a myriad of possible etiologies exists and as such, a detailed history, examination, and, where indicated, imaging is obtained to try and aid with its diagnosis. The purpose of this article is to provide an overview of radial-sided wrist pain, diagnostic modalities and discuss current treatment options. More detailed information is out-of-scope for this article and if needed, we would guide the reader to seek out other selected texts, as indicated.
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Affiliation(s)
| | - Sanjeev Kakar
- Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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7
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Chen RE, Calfee RP, Stepan JG, Osei DA. Outcomes of Acute Versus Subacute Scapholunate Ligament Repair. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:103-110. [PMID: 35434576 PMCID: PMC9005375 DOI: 10.1016/j.jhsg.2021.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/26/2021] [Indexed: 11/05/2022] Open
Abstract
Purpose This study investigated the long-term outcomes of direct scapholunate ligament (SLL) repairs with or without dorsal capsulodesis performed within 6 weeks (acute repair) of a SLL tear versus 6 to 12 weeks following injury (subacute repair). Methods A review of medical records from April 1996 to April 2012 identified 24 patients who underwent SLL repair (12 acute, 12 subacute). Patients returned to the clinic for radiographic examinations of the injured wrist, standardized physical examinations, and validated questionnaires. Results The mean follow-up times for the acute and subacute groups were 7.2 and 6.2 years, respectively. At the final examination, patients with acute surgery regained more wrist extension (acute = 55°, subacute = 47°). The total wrist flexion-extension arcs, grip strengths, pinch strengths, and patient-rated outcome scores were found to be similar between groups. The final scapholunate gap, scapholunate angle, and the prevalence of arthritis were also found to be similar between the acute and subacute groups. Conclusions Although SLL repair is more commonly recommended for treatment of acute SLL injuries, there were no significant long-term differences between acute and subacute SLL surgeries (repair ± capsulodesis). Type of study/level of evidence Prognostic III.
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Affiliation(s)
- Raymond E. Chen
- Department of Orthopedic Surgery, University of Rochester, Rochester, NY
| | - Ryan P. Calfee
- Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Jeffrey G. Stepan
- Department of Orthopaedic Surgery and Rehabilitation Medicine, University of Chicago, Chicago, IL
| | - Daniel A. Osei
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
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Shibayama H, Matsui Y, Kawamura D, Momma D, Endo T, Iwasaki N. Minimum 5-Year Outcomes of Dorsal Intercarpal Ligament Capsulodesis With Scapholunate Interosseous Ligament Repair for Subacute and Chronic Static Scapholunate Instability: A Clinical Series of 5 Patients. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2022; 4:162-165. [PMID: 35601515 PMCID: PMC9120793 DOI: 10.1016/j.jhsg.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 01/12/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hiroki Shibayama
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yuichiro Matsui
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- Corresponding author: Yuichiro Matsui, MD, PhD, Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita 15, Nishi 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
| | - Daisuke Kawamura
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Daisuke Momma
- Center for Sports Medicine, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Endo
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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9
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Micicoi G, Micicoi L, Dreant N. Dorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability. J Hand Surg Eur Vol 2020; 45:666-672. [PMID: 32216521 DOI: 10.1177/1753193420911338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24-127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability.Level of evidence: IV.
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Affiliation(s)
- Grégoire Micicoi
- iULS-University Institute of Locomotion and Sport, University of Côte d'Azur UCA, Nice, France
| | - Lolita Micicoi
- iULS-University Institute of Locomotion and Sport, University of Côte d'Azur UCA, Nice, France
| | - Nicolas Dreant
- Hand Emergency Department, Saint-François Polyclinic, Nice, France
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Pang EQ, Douglass N, Behn A, Winterton M, Rainbow MJ, Kamal RN. The Relationship Between the Tensile and the Torsional Properties of the Native Scapholunate Ligament and Carpal Kinematics. J Hand Surg Am 2020; 45:456.e1-456.e7. [PMID: 31864824 DOI: 10.1016/j.jhsa.2019.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 08/23/2019] [Accepted: 10/15/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this exploratory study was to examine the relationship between the tensile and the torsional properties of the native scapholunate interosseous ligament (SLIL) and kinematics of the scaphoid and lunate of an intact wrist during passive radioulnar deviation. METHODS Eight fresh-frozen cadaveric specimens were transected at the elbow joint and loaded into a custom jig. Kinematic data of the scaphoid and lunate were acquired in a simulated resting condition for 3 wrist positions-neutral, 10° radial deviation, and 30° ulnar deviation-using infrared-emitting rigid body trackers. The SLIL bone-ligament-bone complex was then resected and loaded on a materials testing machine. Specimens underwent cyclic torsional and tensile testing and SLIL tensile and torsional laxity were evaluated. Correlations between scaphoid and lunate rotations and SLIL tensile and torsional properties were determined using Pearson correlation coefficients. RESULTS Ulnar deviation of both the scaphoid and the lunate were found to decrease as the laxity of SLIL in torsion increased. In addition, the ratio of lunate flexion-extension to radial-ulnar deviation was found to increase with increased SLIL torsional rotation. CONCLUSIONS Our findings support the theory that there is a relationship between scapholunate kinematics and laxity at the level of the interosseous ligaments. CLINICAL RELEVANCE Laxity and, specifically, the tensile and torsional properties of an individual's native SLIL should guide reconstruction using a graft material that more closely replicates the individual's native SLIL properties.
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Affiliation(s)
- Eric Quan Pang
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Nathan Douglass
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Anthony Behn
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA
| | - Matthew Winterton
- Department of Orthopaedic Surgery, Penn Medicine University City, Penn Musculoskeletal Center, Philadelphia, PA
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada
| | - Robin N Kamal
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA.
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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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12
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Dorsal Extrinsic Ligament Injury and Static Scapholunate Diastasis on Magnetic Resonance Imaging Scans. J Hand Surg Am 2019; 44:641-648. [PMID: 31047744 DOI: 10.1016/j.jhsa.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 01/19/2019] [Accepted: 03/06/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Current biomechanical data suggest that static scapholunate (SL) ligament dissociation occurs only when there is loss of competence of the extrinsic ligaments either acutely or with attenuation over time. We aimed to identify whether patients with an SL gap greater than 2 mm demonstrated concomitant dorsal radiocarpal ligament (DRC) and dorsal intercarpal ligament (DIC) ligament changes on magnetic resonance imaging (MRI) scans that were identified as having an SL ligament tear. METHODS We included 90 patients who had a posttraumatic MRI scan of the wrist diagnosed with an SL injury. We recorded basic demographics; 2 attending fellowship-trained musculoskeletal radiologists evaluated the integrity of the SL, DRC, and DIC ligaments and graded these as normal, low-grade injury (sprain or partial tear) or full-thickness tear. The association between the integrity of the DRC and DIC ligaments and the presence of a scapholunate gap of 2 mm or greater was analyzed. RESULTS A total of 48 patients (53%) had an SL distance of 2 mm or greater on MRI. Of these patients, 28 (58%) had a partial or total tear of the DIC and/or DRC ligament. Compared with patients with an SL interval less than 2 mm, patients with an SL interval 2 mm or greater more often demonstrated DIC signal change (31% vs 12%), DRC signal change (52% vs 14%), or combined or isolated DIC and/or DRC signal change (52% vs 14%). CONCLUSIONS Dorsal extrinsic ligaments demonstrate MRI signal change suggestive of acute or chronic injury in patients with an SL interval 2 mm or greater more often than in patients with an SL interval less than 2 mm. These results reinforce that MRI findings of SL ligament tear need to be interpreted in a larger context, perhaps with additional attention to the DIC and DRC appearance upon MRI. In addition, MRI evaluation of dorsal extrinsic ligaments may aid in clinical decision-making for patients with SL injury. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic IV.
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13
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Montgomery SJ, Rollick NJ, Kubik JF, Meldrum AR, White NJ. Surgical outcomes of chronic isolated scapholunate interosseous ligament injuries: a systematic review of 805 wrists. Can J Surg 2019; 62:1-12. [PMID: 30900438 PMCID: PMC6738500 DOI: 10.1503/cjs.006918] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 11/01/2022] Open
Abstract
Background Management of chronic isolated scapholunate interosseous ligament (SLIL) injuries has generated a substantial volume of low-quality literature with descriptions of multiple new surgical techniques, and the impact of instability pattern and the optimal surgical technique remain unclear. The primary goal of this review was to compare clinical, radiographic and patient-rated outcomes between current surgical techniques. Methods We performed a systematic literature search using multiple databases. We analyzed clinical, radiographic and patient-reported outcomes. We used a fixed-effects model weighted by sample size with combined outcomes estimated via least squares means with 95% confidence intervals. We also performed a subgroup analysis of static versus dynamic instability. Results We assessed 805 procedures from 37 study groups, with 429 procedures used in subgroup analysis. There were no statistically significant differences in outcomes between surgical techniques or in subgroup analysis. Overall, postoperative wrist flexion and pain scores decreased, and grip strength and patient-rated outcomes improved. Conclusion Compared to overall preoperative values, modest improvements in pain score, grip strength and functional outcome scores were obtained from a range of reconstructive procedures performed for chronic isolated SLIL injuries. No significant differences could be ascertained between surgical techniques, potentially owing to the low quality of evidence and procedure heterogeneity. This study provides accurate preoperative reference values for future studies, highlights the controversial clinical impact of instability classification, and the need for higher-quality multicentre or collaborative trials to improve our understanding and management of this common injury.
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14
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Pang EQ, Douglass N, Behn A, Winterton M, Rainbow MJ, Kamal RN. Tensile and Torsional Structural Properties of the Native Scapholunate Ligament. J Hand Surg Am 2018; 43:864.e1-864.e7. [PMID: 29459171 DOI: 10.1016/j.jhsa.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 12/26/2017] [Accepted: 01/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE The ideal material for reconstruction of the scapholunate interosseous ligament (SLIL) should replicate the mechanical properties of the native SLIL to recreate normal kinematics and prevent posttraumatic arthritis. The purpose of our study was to evaluate the cyclic torsional and tensile properties of the native SLIL and load to failure tensile properties of the dorsal SLIL. METHODS The SLIL bone complex was resected from 10 fresh-frozen cadavers. The scaphoid and lunate were secured in polymethylmethacrylate and mounted on a test machine that incorporated an x-y stage and universal joint, which permitted translations perpendicular to the rotation/pull axis as well as nonaxial angulations. After a 1 N preload, specimens underwent cyclic torsional testing (±0.45 N m flexion/extension at 0.5 Hz) and tensile testing (1-50 N at 1 Hz) for 500 cycles. Lastly, the dorsal 10 mm of the SLIL was isolated and displaced at 10 mm/min until failure. RESULTS During intact SLIL cyclic torsional testing, the neutral zone was 29.7° ± 6.6° and the range of rotation 46.6° ± 7.1°. Stiffness in flexion and extension were 0.11 ± 0.02 and 0.12 ± 0.02 N m/deg, respectively. During cyclic tensile testing, the engagement length was 0.2 ± 0.1 mm, the mean stiffness was 276 ± 67 N/mm, and the range of displacement was 0.4 ± 0.1 mm. The dorsal SLIL displayed a 0.3 ± 0.2 mm engagement length, 240 ± 65 N/mm stiffness, peak load of 270 ± 91 N, and displacement at peak load of 1.8 ± 0.3 mm. CONCLUSIONS We report the torsional properties of the SLIL. Our novel test setup allows for free rotation and translation, which reduces out-of-plane force application. This may explain our observation of greater dorsal SLIL load to failure than previous reports. CLINICAL RELEVANCE By matching the natural ligament with respect to its tensile and torsional properties, we believe that reconstructions will better restore the natural kinematics of the wrist and lead to improved outcomes. Future clinical studies should aim to investigate this further.
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Affiliation(s)
| | | | | | - Matthew Winterton
- Department of Orthopaedic Surgery, Penn Medicine University City, Penn Musculoskeletal Center, Philadelphia, PA
| | - Michael J Rainbow
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Ontario, Canada
| | - Robin N Kamal
- Stanford University Department of Orthopaedic Surgery - North Campus, Redwood City, CA.
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15
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Abstract
Scapholunate ligament (SLL) injuries are a common cause of wrist pain and instability. Treatment of SLL injuries requires intricate understanding of wrist anatomy and biomechanics. Mindful physical exam and appropriate diagnostic studies can orient the surgeon to the defined stage of injury. Review of the literature on each treatment by stage can prepare the upper extremity surgeon to provide the best evidence-based care. The optimal management of SLL injuries should result in a stable, painless wrist.
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Affiliation(s)
- Geoffrey Konopka
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA,
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL, USA,
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16
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17
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Abstract
Injuries to the scapholunate joint are the most common cause of carpal instability. An isolated injury to the scapholunate ligament may progress to abnormal joint mechanics and degenerative cartilage changes. Treatment for scapholunate instability is aimed at arresting the degenerative process by restoring ligament continuity and normalising carpal kinematics. Early arthroscopic diagnosis of scapholunate injury is mandatory for establishing the prognosis of the injury, as a proper ligament repair is recommended within four to six weeks after trauma. In this review, anatomy, diagnosis and treatment of scapholunate ligament injury and carpal instability are discussed. Recommendations for treatment based on the stage and classification of injury and the degree of instability and arthritic changes are proposed.
Cite this article: EFORT Open Rev 2017;2:382–393. DOI: 10.1302/2058-5241.2.170016
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Affiliation(s)
- Jonny K Andersson
- Department of Hand Surgery, Sahlgrenska University Hospital, Göteborg, Sweden and Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
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De Carli P, Donndorff AG, Torres MT, Boretto JG, Gallucci GL. Combined Tenodesis-Capsulodesis for Scapholunate Instability: Minimum 2-Year Follow-Up. J Wrist Surg 2017; 6:11-21. [PMID: 28119791 PMCID: PMC5258132 DOI: 10.1055/s-0036-1583304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
Abstract
Background The aim of this study is to evaluate the clinical and radiological midterm results of a combined dorsal tenodesis-capsulodesis for static and reducible scapholunate dissociation (SLD). Patients and Methods We evaluated 20 of 22 consecutive patients with static SLD minimum with follow-up of 2 years operated between 2003 and 2012. The mean age was 40 years (range: 23-65 years). Seventeen were men. Final evaluation included comparative wrist range of motion (ROM) and grip strength, pre- and postoperative pain and function by visual analog scale, and QuickDASH and Wrightington scores. Radiographs included preoperative, early postoperative, and final X-rays. Scapholunate space (SLS) and scapholunate and radioscaphoid angles (SLA and RSA) were measured. Statistical significance was evaluated with Student t-test, considered significant when p < 0.05. Results Mean follow-up was 67 months (range: 24-126 months). Mean final ROM was: flexion 55 degrees (73%), extension 62 degrees (90%), radial deviation 19 degrees (82%), and ulnar deviation 44 degrees (90%). Mean grip strength was 44 kg (92%). Pain at rest improved from 3.4 to 0.5 (p < 0.05). Pain in activity improved from 7 to 1.7 (p < 0.05). Final function was 8.5 (preoperative, 5.2; p < 0.05). Mean QuickDASH score improved from 38 to 8 (p < 0.05). Functional Wrightington score was as follows: 13 excellent, 3 good, 1 regular, and 3 poor. There were three postoperative minor complications. Radiological results (preoperative/early postoperative/final follow-up) were as follows: SLS, 4.7/1.6/1.8 mm; and SLA, 60/50/62 degrees; RSA, 39/45/37 degrees. Four patients showed arthritic changes (two SLAC wrist). Conclusion The clinical and radiological results with more than 2-year follow-up suggest that this technique may be effective, reproducible, and safe for symptomatic static and reducible SLD. Level of Evidence Level IV, case series.
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Affiliation(s)
- Pablo De Carli
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Agustin G. Donndorff
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Miguel Tovar Torres
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Jorge G. Boretto
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
| | - Gerardo L. Gallucci
- Hospital Italiano de Buenos Aires, “Carlos E. Ottolenghi” Institute, Hand Surgery and Upper Extremity Center, Buenos Aires, Argentina
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Abstract
The scapholunate ligament is both a key ligament in the stability of the carpus and one of the most frequently injured. Thorough understanding of the anatomy, biomechanics, and pathophysiology of the wrist is important in treating injuries to the scapholunate ligament. The presentation of scapholunate instability often includes a vague injury history and pain with grip, wrist extension, and sport or labor. Identified injuries are classified based on dynamic and static radiographic findings, chronicity, and the presence or absence of arthrosis. Surgical options for the treatment of low- and high-grade injuries include both open and arthroscopic procedures and can be broadly classified into four categories: limited arthroscopic procedures, primary ligament repair, reconstructive procedures, and salvage procedures. No strong evidence currently supports any one treatment. Decision making is largely based on expert opinion and surgeon experience. Prognosis is often guarded, and patient expectations should be tempered.
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Rajan PV, Day CS. Scapholunate ligament insufficiency. J Hand Surg Am 2015; 40:583-5. [PMID: 25499841 DOI: 10.1016/j.jhsa.2014.10.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/17/2014] [Indexed: 02/02/2023]
Affiliation(s)
- Prashant V Rajan
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
| | - Charles S Day
- Department of Orthopedic Surgery, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA.
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Abstract
The scaphoid is stabilized by the scapholunate ligament (directly) and lunotriquetral ligament (indirectly). Disruption of either of these ligaments leads to a pattern of instability that, left untreated, leads to altered mechanics of the wrist and ultimately debilitating arthritis and collapse. Although arthroscopy remains the gold standard for diagnosis of these injuries, plain films and advanced imaging are useful adjuncts. In the acute setting, conservative treatment may be attempted, but recalcitrant cases require surgical stabilization. Salvage procedures are also available for those patients who fail initial stabilization or present with late degeneration.
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Affiliation(s)
- Nicholas Caggiano
- Department of Orthopaedic Surgery, St. Luke's University Hospital, 801 Ostrum Street, PPH-2, Bethlehem, PA 18015, USA
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Finsen V, Borchgrevink GE. Poor results of radio-scaphoid capsulodesis for scapholunate dissociation. HAND SURGERY : AN INTERNATIONAL JOURNAL DEVOTED TO HAND AND UPPER LIMB SURGERY AND RELATED RESEARCH : JOURNAL OF THE ASIA-PACIFIC FEDERATION OF SOCIETIES FOR SURGERY OF THE HAND 2013; 18:337-41. [PMID: 24156575 DOI: 10.1142/s0218810413500366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We reviewed 17 patients 64 (range 29-123) months after dorsal radioscaphoid capsulodesis for scapholunate dissociation. Mean loss of key pinch was 13%, grip strength 18%, wrist flexion 22% (p < 0.001), and total wrist ROM 17% (p < 0.005). VAS (0 = best; 100 = worst) was 30(±28) for pain, 43(±30) for function, and 33(±33) for general satisfaction with the outcome. Mean Quick-DASH and PRWE scores were 27 and 34, respectively. The mean scapholunate gap was 3.5 mm before surgery, 1.9 mm after surgery, and 3.3 mm at review. The corresponding scapholunate angles were 63°, 46°, and 70°, respectively. The mean radioscaphoid angle with the wrist maximally flexed was 84° (69-99) for the patients and was 91° (77-103) in ten wrists of volunteers. Six patients had changed their jobs because of the wrist. Three patients stated that they would not have consented to operation if they had known the outcome in advance. Radioscaphoid capsulodesis does not prevent volar flexion of the scaphoid.
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Affiliation(s)
- Vilhjalmur Finsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway , Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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