Scapholunate Ligament Repair and Capsulodesis for the Treatment of Static Scapholunate Dissociation

1998 ◽  
Vol 23 (6) ◽  
pp. 776-780 ◽  
Author(s):  
J. D. WYRICK ◽  
B. D. YOUSE ◽  
T. R. KIEFHABER
Keyword(s):  
Grading System ◽  
Scapholunate Ligament ◽  
Scapholunate Dissociation ◽  
Ligament Repair ◽  
Wrist Motion ◽  
Normal Side ◽  
Scapholunate Instability ◽  
Clinical Grading ◽  
Radiographic Grading

Twenty-four patients were treated with scapholunate ligament repair and dorsal capsulodesis for scapholunate dissociation. Seventeen patients were available for follow-up at an average of 30 months. The average interval between injury and surgery was 3 months. At final follow-up, no patients were pain-free. Average total wrist motion was 60% and grip strength 70% of the opposite normal side. The average preoperative scapholunate angle was 78° and was corrected to a normal 47° at surgery. The average final scapholunate angle was 72°, which was not significantly different from the preoperative value. The scapholunate gap likewise was not significantly changed postoperatively. Only two patients had an excellent or good outcome using a clinical grading system, and six out of 17 scored good or excellent using a radiographic grading system. In conclusion, repair of the scapholunate ligament with dorsal capsulodesis failed to provide consistent pain relief and maintain carpal alignment in patients with static scapholunate instability.

DORSAL CAPSULODESIS AND LIGAMENTOPLASTY FOR CHRONIC PRE-DYNAMIC AND DYNAMIC SCAPHOLUNATE DISSOCIATION

Hand Surgery ◽  
2003 ◽  
Vol 08 (02) ◽  
pp. 173-178 ◽  
Author(s):  
Jui-Tien Shih ◽  
Hung-Maan Lee ◽  
Yao-Tung Hou ◽  
Sheng-Tsi Horng ◽  
Chuan-Ming Tan
Keyword(s):  
Grip Force ◽  
Therapeutic Option ◽  
Dominant Hand ◽  
Scapholunate Dissociation ◽  
Wrist Motion ◽  
Normal Side ◽  
Dynamic Type ◽  
Flexion Extension ◽  
Average Patient

Scapholunate (SL) instability is the most common cause of carpal instability. Pre-dynamic and dynamic type SL instability is difficult to diagnose and treat. This series reviews 17 soldiers with pre-dynamic or dynamic SL instability diagnosed by midcarpal arthroscopy and treated with dorsal capsulodesis and augmentation ligamentoplasty with partial dorsal radiocarpal (DRC) ligament procedure between 1997 and 2000. The sample included 14 males and three females. The dominant hand was involved in 15 patients. Moreover, the average patient age was 29.3 years (range 19–36 years). The diagnosis was based on clinical and arthroscopic criteria. Fifteen patients were followed up at our clinic regularly, with the follow-up period ranging from 12 to 39 months (mean 25.2 months). Fourteen patients had excellent or good results, and one patient had poor result based on Mayo Modified Wrist Score. Wrist motion in the flexion-extension plane loss averaged 18.4°. Grip force increased significantly following treatment, with improvement totaling 15% of normal side. No complications were found in this series. Consequently, dorsal capsulodesis and ligamentoplasty with partial DRC ligament is considered a valuable therapeutic option for cases of pre-dynamic and dynamic SL instability.

Dorsal intercarpal ligament capsulodesis for predynamic and dynamic scapholunate instability

2009 ◽  
Vol 35 (1) ◽  
pp. 32-37 ◽  
Author(s):  
R. Luchetti ◽  
I. Papini Zorli ◽  
A. Atzei ◽  
T. Fairplay
Keyword(s):  
Grip Strength ◽  
Open Surgery ◽  
Wrist Arthroscopy ◽  
Scapholunate Dissociation ◽  
Wrist Motion ◽  
Scapholunate Instability ◽  
Mayo Wrist Score ◽  
The Mean ◽  
Dash Questionnaire

We treated a prospective series of 18 patients (nine men and nine women) with a mean age of 35 years (range 15 to 57), with chronic predynamic or dynamic scapholunate instability by a dorsal intercarpal ligament capsulodesis using the modified Mayo technique. All the patients were assessed by the modified Mayo wrist score and DASH questionnaire. Wrist arthroscopy was done in all patients before open surgery in order to grade the scapholunate instability and correlate the findings with the radiographic and MRI results. At an average follow-up of 45 months (range 34 to 60) pain significantly diminished ( P < 0.05) with improvement in the grip strength ( P < 0.005) in all 18 cases. Wrist motion remained almost the same. The mean Mayo wrist score improved from 62 to 84 ( P < 0.005).We recommend dorsal capsulodesis by using the dorsal intercarpal ligament flap for the treatment of scapholunate dissociation, when the ligament is still repairable.

HERBERT SCREW FIXATION FOR THE TREATMENT OF SCAPHOLUNATE LIGAMENT RUPTURE

Hand Surgery ◽  
1998 ◽  
Vol 03 (01) ◽  
pp. 47-55 ◽  
Author(s):  
Susan L. Filan ◽  
Timothy J. Herbert
Keyword(s):  
Open Reduction ◽  
Screw Fixation ◽  
Moderate Activity ◽  
Activity Levels ◽  
Scapholunate Ligament ◽  
Ligament Repair ◽  
Wrist Motion ◽  
Bone Screw ◽  
Ligament Rupture ◽  
Full Loading

Complete rupture of the scapholunate ligament was treated by open reduction, ligament repair and internal splintage with a Herbert bone screw. After an average of 12 months, the screw was removed to allow full loading of the repair. In 33 procedures, there were 22 good and 11 poor results. In five cases with a poor outcome, the screw pulled or fractured out of the scaphoid or lunate. Grip and range of wrist motion improved in patients with a good outcome, and repair of the ligament was noted at all revision and open screw removal surgeries. A comparison of the good and poor results leads us to recommend this technique for patients with relatively recent injuries and light to moderate activity levels. Longstanding injuries and heavy occupational wrist loading led to poorer results.

Proximal Scaphoid Costo-Osteochondral Replacement Arthroplasty

1998 ◽  
Vol 23 (2) ◽  
pp. 201-208 ◽  
Author(s):  
M. J. SANDOW
Keyword(s):  
Grip Strength ◽  
Proximal Pole ◽  
Function Score ◽  
Scapholunate Ligament ◽  
Medium Term ◽  
Wrist Motion ◽  
Osteochondral Autograft ◽  
Replacement Arthroplasty ◽  
Wrist Function

Deficiency of the proximal pole of the scaphoid due to fracture or necrosis was treated by costo-osteochondral replacement arthroplasty using rib bone/cartilage autografts in 22 patients who were followed prospectively and assessed at a median 24 month follow-up (range, 12–72 months). Improvement of wrist function occurred in all patients with increased motion, improved grip strength and less pain. The average modified Green and O’Brien Wrist Function Score improved from 53 out of 100 preoperatively to 80 at the most recent review. All patients were graded fair or poor at initial review and all but three improved to good or excellent at the most recent assessment. Despite the absence of the scapholunate ligament, carpal alignment did not deteriorate in any patient and there were no graft non-unions or significant complications. In the short and medium term a costo-osteochondral autograft can satisfactorily restore mechanical integrity of the scaphoid proximal pole and maintain wrist motion while avoiding the potential complications of alternative replacement arthroplasty techniques.

Scapholunate Ligament Repair Using the Mitek™ Bone Anchor

2000 ◽  
Vol 25 (2) ◽  
pp. 188-192 ◽  
Author(s):  
B. BICKERT ◽  
M. SAUERBIER ◽  
G. GERMANN
Keyword(s):  
Retrospective Study ◽  
Functional Result ◽  
Functional Results ◽  
Scapholunate Ligament ◽  
Ligament Repair ◽  
Bone Anchor ◽  
Excellent Functional Result ◽  
Lunate Necrosis

A retrospective study was done to assess the outcome after repair of completely ruptured scapholunate interosseous ligaments using the Mitek™ Mini G2 bone anchor. From 1994 to 1996. 12 patients underwent scapholunate ligament repair using the bone anchor. A follow-up assessment was done at a mean of 19 months postoperatively and revealed excellent or good results in eight patients, satisfactory in two, and poor in two patients, one of whom had developed lunate necrosis. One patient with an excellent functional result demonstrated recurrent dissociation of the scapholunate gap radiographically. The technique described proved to be simpler than conventional procedures in our hands, and yields similar functional results.

Modified Viegas dorsal capsuloplasty for chronic partial injury of the scapholunate ligament in young athletes: outcomes at 24 months

2020 ◽  
Vol 45 (9) ◽  
pp. 945-951
Author(s):  
Norman Della Rosa ◽  
Gianluca Sapino ◽  
Fabio Vita ◽  
Pietro G. di Summa ◽  
Roberto Adani
Keyword(s):  
Scapholunate Ligament ◽  
High Demand ◽  
Young Athletes ◽  
Level Of Evidence ◽  
Wrist Motion ◽  
Ligament Tear ◽  
Competitive Activity ◽  
Scapholunate Ligament Tear ◽  
Retrospective Investigation

The treatment of chronic scapholunate ligament tears in patients with high demand, such as young athletes, is difficult as traditional techniques are associated with some loss of wrist motion and grip strength. This retrospective investigation studied young athletes (≤20 years old) with chronic scapholunate ligament lesions and a minimum follow-up of 24 months, treated with a modified Viegas dorsal capsuloplasty. Twenty-six young athletes (mean age 17 years) were included. A partial scapholunate ligament tear (Geissler III) was seen in 25 patients. At the last follow-up, a significantly different improvement was seen in all measured parameters and all patients could return to their original competitive activity, within 6 months (range 4–12) after surgery. Level of evidence: IV

Four corner arthrodesis limited to the centre using a scaphoid one piece graft and a dorsal circular plate

2009 ◽  
Vol 35 (1) ◽  
pp. 38-42 ◽  
Author(s):  
G. Mantovani ◽  
C. Mathoulin ◽  
W. Y. Fukushima ◽  
A. B. Cho ◽  
M. A. Aita ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Circular Plate ◽  
Central Area ◽  
Dash Score ◽  
Cancellous Bone Graft ◽  
Scaphoid Nonunion ◽  
Scapholunate Dissociation ◽  
Wrist Motion ◽  
Technical Modifications

We present 20 patients, who had a four corner arthrodesis, from July 2006 to March 2008, using a dorsal circular plate, to treat scaphoid nonunion and scapholunate dissociation with advanced collapse (SNAC, SLAC). The surgical technique was a fusion restricted to the central area filled with one piece of cancellous bone graft taken from the excised scaphoid. Wrist motion, grip strength, and Disabilities of Arm Shoulder and Hand (DASH) score improved after surgery at a mean follow-up of 20.2 months. Fusion occurred in 19/20 patients. Two patients (10%) had persistent pain. The rest had a good clinical result. We found that four-corner fusion using a dorsal circular plate using the specific technical modifications was successful.

Radiographic evaluation of a novel horizontal dorsal intercarpal capsulodesis as a treatment of pre-arthritic scapholunate dissociation: a cadaver study

2014 ◽  
Vol 40 (5) ◽  
pp. 502-511 ◽  
Author(s):  
E. Payet ◽  
D. Bourguignon ◽  
I. Auquit-Auckbur ◽  
F. Duparc ◽  
F. Dujardin
Keyword(s):  
Cadaver Study ◽  
Radiographic Evaluation ◽  
Scapholunate Ligament ◽  
Scapholunate Dissociation ◽  
Ulnar Deviation ◽  
Scapholunate Instability ◽  
Before And After ◽  
Fresh Frozen ◽  
The Creation ◽  
Cadaveric Model

Dorsal capsulodesis is an important part of the treatment of pre-arthritic scapholunate instability. We designed an experimental study using 14 fresh-frozen cadaver wrists to demonstrate the efficacy of a new horizontal dorsal intercarpal capsulodesis. We sectioned the scapholunate ligament to create a scapholunate dislocation. Several radiographic views, static and ‘in stress’, were recorded and we statistically compared the scapholunate interval before and after the section of the scapholunate ligament, and after the creation of the capsulodesis. The results showed a significant decrease of the scapholunate interval after the creation of the capsulodesis, especially in neutral and maximal ulnar deviation of the wrist. They also proved that our cadaveric model is reliable. This study demonstrated that this novel capsulodesis reduces the scapholunate interval in a cadaveric model.

Dart-throwing motion in patients with scapholunate instability: a dynamic four-dimensional computed tomography study

2013 ◽  
Vol 39 (4) ◽  
pp. 346-352 ◽  
Author(s):  
M. Garcia-Elias ◽  
X. Alomar Serrallach ◽  
J. Monill Serra
Keyword(s):  
Computed Tomography ◽  
Computer Tomography ◽  
Frontal Plane ◽  
Scapholunate Ligament ◽  
Ligament Repair ◽  
Scapholunate Instability ◽  
Radial Styloid ◽  
Dart Throwing ◽  
Midcarpal Joint ◽  
Throwing Motion

When the normal wrist rotates along the ‘dart-throwing’ plane, the proximal row remains still, with most motion occurring at the midcarpal joint. Whether this behaviour is maintained when the scapholunate ligaments are torn is not known. If this is the case, patients having a scapholunate ligament repair could benefit from early dart-throwing exercises without the risk of pulling the sutures apart. Using dynamic computer tomography, we analysed the carpal behaviour of six normal wrists and six wrists with scapholunate instability during dart-throwing motion. In the normal wrists, the scaphoid and lunate did not flex or extend, but translated along the frontal plane an average 5.9 and 5.6 mm, respectively. When the scapholunate ligaments were torn, the scaphoid shifted towards the radial styloid considerably more than the lunate (12.8 mm versus 4.8 mm; p = 0.005), inducing a scapholunate gap. Based on these findings, we cannot recommend dart-throwing exercises after scapholunate ligament repair, unless the joint is stabilized with wires or screws.

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