scholarly journals Modern approaches to the treatment of scapholunate interosseous ligament injuries (literature review)

2020 ◽  
Vol 26 (4) ◽  
pp. 593-599
Author(s):  
O.G. Shershneva ◽  
◽  
I.V. Kirpichev ◽  
Keyword(s):  
Primary Repair ◽  
Clinical Manifestations ◽  
Tendon Graft ◽  
Open Approach ◽  
Scapholunate Ligament ◽  
Ligament Injuries ◽  
Chronic Instability ◽  
Interosseous Ligament ◽  
Acute Injuries ◽  
Arthroscopically Assisted

Introduction The scapholunate interosseous ligament binds the scaphoid and lunate together, and is the primary stabilising ligament between these two bones. Scapholunate injuries lead to chronic instability and degenerative arthritis of the wrist. Scapholunate injuries are graded based on the acuity and the severity of the injury. Purpose The paper is a review of various techniques used to repair or reconstruct the scapholunate ligament according to the clinical manifestations, anatomic and pathologic findings. Methods A review of the literature covering this topic is presented. Results Conservative treatment is primarily indicated in stable and partial ligament tears. Arthroscopic treatment is used when immobilization is unsuccessful. Arthroscopically assisted scapholunate reduction and K-wire fixation is commonly used for acute injuries. Primary repair of scapholunate injuries are performed in all tear types using an open approach. Surgical indications depend on the severity of the instability, time after trauma and the presence of degenerative changes. Acute repair of scapholunate ligament injuries remains the gold standard as an earlier intervention provides better results. Acute injuries to the scapholunate ligament require two-four weeks before surgery. Within this period the ligament is often still repairable itself both with or without supplementary capsulodesis procedures; ligament reconstruction is generally preferable in patients with chronic injures. There are many arthroscopic techniques to treat chronic scapholunate injures such as scapholunate ligament primary repair using various types of capsulodesis, tendon graft reconstruction, bone-ligament-bone procedure, various intercarpal fusions and proximal row carpectomy, total wrist fusion and arthroplasty. Conclusion Early diagnosis and management of scapholunate ligament tears are necessary to preserve wrist functions.

scholarly journals Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results

2020 ◽  
Vol 09 (04) ◽  
pp. 328-337
Author(s):  
Vicente Carratalá ◽  
Francisco Javier Lucas ◽  
Ignacio Miranda ◽  
Alfonso Prada ◽  
Eva Guisasola ◽  
...  
Keyword(s):  
Grip Strength ◽  
Soft Tissues ◽  
Primary Repair ◽  
Acute Injury ◽  
Prospective Clinical Study ◽  
Scapholunate Ligament ◽  
Dorsal Approach ◽  
Perilunate Dislocation ◽  
Acute Injuries ◽  
Aggressive Interventions

Abstract Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained. Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded. Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

scholarly journals Kinematic analysis of two scapholunate ligament reconstruction techniques

2021 ◽  
Vol 29 (2) ◽  
pp. 230949902110258
Author(s):  
Seungbum Chae ◽  
Junho Nam ◽  
Il-Jung Park ◽  
Steven S. Shin ◽  
Michelle H. McGarry ◽  
...  
Keyword(s):  
Kinematic Analysis ◽  
Clinical Relevance ◽  
Ligament Reconstruction ◽  
Operative Time ◽  
Efficient Technique ◽  
Scapholunate Ligament ◽  
Interosseous Ligament ◽  
Flexion Extension

Purpose: This study compares the kinematic changes after the procedures for scapholunate interosseous ligament (SLIL) reconstruction—the modified Brunelli technique (MBT) and Mark Henry’s technique (MHT). Methods: Ten cadaveric wrists were used. The scapholunate (SL) interval and angle and radiolunate (RL) angle were recorded using the MicroScribe system. The SL interval was measured by dividing the volar and dorsal portions. Four motions of the wrist were performed—neutral, flexion, extension, and clenched fist (CF) positions—and compared among five conditions: (1) intact wrist, (2) volar SLIL resection, (3) whole SLIL resection, (4) MBT reconstruction, and (5) MHT reconstruction. Results: Under the whole SLIL resection condition, the dorsal SL intervals were widened in all positions. In all positions, the dorsal SL intervals were restored after MBT and MHT. The volar SL interval widened in the extension position after volar SLIL resection. The volar SL interval was not restored in the extension position after MBT and MHT. The SL angle increased in the neutral and CF positions under the whole SLIL resection condition. The SL angle was not restored in the neutral and CF positions after MBT and MHT. The RL angle increased in the neutral and CF positions under the whole SLIL resection condition. The RL angle was not restored in the neutral and CF positions after MBT and MHT. Conclusion: The MBT and MHT may restore the dorsal SL interval. No significant differences in restoration of the SL interval between MBT and MHT were found in the cadaveric models. Clinical relevance: No significant differences between MBT and MHT were found in the cadaveric models for SLIL reconstruction. When considering the complications due to volar incision and additional procedures in MHT, MBT may be a more efficient technique in terms of operative time and injury of the anterior structures during surgery, but further research is needed.

Outcomes Following Surgical Treatment of Hamate Arthrosis Lunotriquetral Ligament Injuries

Hand ◽  
2021 ◽  
pp. 155894472110432
Author(s):  
Jesse Meaike ◽  
Joshua Meaike ◽  
Sanjeev Kakar
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Combined Treatment ◽  
Additional Treatment ◽  
Ligament Injuries ◽  
Interosseous Ligament ◽  
Institutional Review ◽  
Lunotriquetral Ligament ◽  
Treatment Plans ◽  
And Function

Background: An institutional review board–approved study of the functional outcomes of patients after surgical treatment of hamate arthrosis lunotriquetral ligament tear (HALT) lesions was conducted. Methods: In all, 21 wrists in 19 patients underwent arthroscopic, open, or combined treatment of HALT lesions. Seven patients underwent isolated hamate debridement and 14 had concomitant procedures to address lunotriquetral pathology. Nineteen wrists underwent procedures to address additional pathology, including triangular fibrocartilage complex, ulnotriquetral ligament split, and scapholunate ligament injuries. Results: Mayo wrist scores increased from 54 to 71. Sixteen patients had no or mild pain postoperatively, compared with none preoperatively. When stratified by lunotriquetral interosseous ligament management, 75% of the limited treatment group (none or debridement) and 78% of the additional treatment group reported improved pain. Three patients underwent additional surgeries for persistent pain. Conclusion: Resection of the proximal pole of the hamate can improve pain and function for patients with ulnar-sided wrist pain secondary to a HALT lesion. Concomitant wrist pathologies should be considered when determining treatment plans.

Lunate morphology: association with the severity of scapholunate ligament injuries and carpal instability patterns

2021 ◽  
pp. 1-9
Author(s):  
Katarzyna Rachunek ◽  
Fabian Springer ◽  
Maja Barczak ◽  
Theodora Wahler ◽  
Adrien Daigeler ◽  
...  
Keyword(s):  
Carpal Instability ◽  
Scapholunate Ligament ◽  
Ligament Injuries

Primary Repair for Posterior Cruciate Ligament Injuries

1996 ◽  
Vol 24 (3) ◽  
pp. 298-305 ◽  
Author(s):  
Marcus Richter ◽  
Hartmuth Kiefer ◽  
Gerhard Hehl ◽  
Lothar Kinzl
Keyword(s):  
Posterior Cruciate Ligament ◽  
Primary Repair ◽  
Cruciate Ligament ◽  
Ligament Injuries

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears

2017 ◽  
Vol 42 (4) ◽  
pp. 346-351 ◽  
Author(s):  
R. Luchetti ◽  
A. Atzei
Keyword(s):  
Late Onset ◽  
Tendon Graft ◽  
Triangular Fibrocartilage Complex ◽  
Forearm Rotation ◽  
Level Of Evidence ◽  
Evaluation Scores ◽  
Complex Reconstruction ◽  
Arthroscopically Assisted ◽  
Triangular Fibrocartilage

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. Level of evidence: IV

Outcomes of primary and recurrent inguinal hernia repair with prosthetic mesh in a single region over 15 years

2021 ◽  
Vol 103 (7) ◽  
pp. 493-495
Author(s):  
L Smith ◽  
D Magowan ◽  
R Singh ◽  
BM Stephenson
Keyword(s):  
Inguinal Hernia ◽  
Mesh Repair ◽  
Primary Repair ◽  
Prosthetic Mesh ◽  
Recurrent Inguinal Hernia ◽  
Open Approach ◽  
Symptomatic Recurrence ◽  
Single Region ◽  
Open Mesh Repair ◽  
Recurrent Herniation

Background Sutured inguinal hernia repairs are now uncommon, with evidence suggesting that those augmented with mesh are associated with a lower recurrence rate. We aimed to explore the suggestion that the established use of mesh does indeed lower the rate of operation for recurrence in a single National Health Service region. Method We collected retrospective Office of Population Censuses and Surveys coded data across one region of all primary and recurrent inguinal hernia repairs over 15 years (2004–2019). Electronic records of recurrent repairs were scrutinised to identify year and type of previous primary repair. Results In total, 7,234 repairs were performed during this time, of which 289 (4%) were for symptomatic recurrence. Operations for primary repair increased year on year (111 in 2004 to 402 in 2019). Frequency of operation for recurrent herniation declined with increasing use of mesh (8.8% in 2004 to 3.5% in 2019). The majority of repairs (73%) for recurrence were by an open approach. As opposed to an open mesh repair, a primary laparoscopic repair was associated with an earlier recurrence. Conclusions Inguinal hernia repairs are increasing in frequency but operations for later symptomatic recurrence following an open primary prosthetic mesh repair are not.

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