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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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Gietzen CH, Kunz AS, Luetkens KS, Huflage H, Christopoulos G, van Schoonhoven J, Bley TA, Schmitt R, Grunz JP. Evaluation of prestyloid recess morphology and ulnar-sided contrast leakage in CT arthrography of the wrist. BMC Musculoskelet Disord 2022; 23:284. [PMID: 35331212 PMCID: PMC8944076 DOI: 10.1186/s12891-022-05241-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/17/2022] [Indexed: 11/20/2022] Open
Abstract
Background In wrist arthrograms, aberrant contrast material is frequently seen extending into the soft tissue adjacent to the ulnar styloid process. Since the prestyloid recess can mimic contrast leakage in CT arthrography, this study aims to provide a detailed analysis of its morphologic variability, while investigating whether actual ulnar-sided leakage is associated with injuries of the triangular fibrocartilage complex (TFCC). Methods Eighty-six patients with positive wrist trauma history underwent multi-compartment CT arthrography (40 women, median age 44.5 years). Studies were reviewed by two board-certified radiologists, who documented the morphology of the prestyloid recess regarding size, opening type, shape and position, as well as the presence or absence of ulnar-sided contrast leakage. Correlations between leakage and the presence of TFCC injuries were assessed using the mean square contingency coefficient (rɸ). Results The most common configuration of the prestyloid recess included a narrow opening (73.26%; width 2.26 ± 1.43 mm), saccular shape (66.28%), and palmar position compared to the styloid process (55.81%). Its mean length and anterior–posterior diameter were 6.89 ± 2.36 and 5.05 ± 1.97 mm, respectively. Ulnar-sided contrast leakage was reported in 29 patients (33.72%) with a mean extent of 12.30 ± 5.31 mm. Leakage occurred more often in patients with ulnar-sided TFCC injuries (rɸ = 0.480; p < 0.001), whereas no association was found for lesions of the central articular disc (rɸ = 0.172; p = 0.111). Conclusions Since ulnar-sided contrast leakage is more common in patients with peripheral TFCC injuries, distinction between an atypical configuration of the prestyloid recess and actual leakage is important in CT arthrography of the wrist.
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Affiliation(s)
- Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Georgios Christopoulos
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany.,Department of Radiology, University Hospital LMU Munich, Marchioninistraße 15, 81377, Munich, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany. .,Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Straße 11, 97616, Bad Neustadt an der Saale, Germany.
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Wrist and Hand Trauma Imaging. Clin Sports Med 2021; 40:625-639. [PMID: 34509202 DOI: 10.1016/j.csm.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Injuries to the wrist and hands occur frequently in athletes from the high forces applied during sporting events. The examples presented illustrate the important role imaging has in the diagnosis of wrist and hand injuries. In addition, different imaging modalities are complementary and various examinations may be needed to help guide the management of wrist and hand traumatic pathology.
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Hesse N, Schmitt R, Luitjens J, Grunz JP, Haas-Lützenberger EM. Carpal Instability: II. Imaging. Semin Musculoskelet Radiol 2021; 25:304-310. [PMID: 34374065 DOI: 10.1055/s-0041-1730398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Beyond clinical examination, the various forms of carpal instability are assessed with radiologic methods and arthroscopy. For this purpose, the imaging demand for spatial and contrast resolution is particularly high because of the small ligamentous structures involved. The entities of carpal instability are classified into degrees of severity. Early (dynamic) forms of instability can either be indirectly detected with X-ray stress views and cineradiography or by direct visualization of ruptured ligaments in high-resolution magnetic resonance (MR) imaging and MR or computed tomography (CT) arthrography, with the latter the standard of reference in imaging. Advanced (static) forms of carpal instability are sufficiently well detected on radiographs; visualization of early carpal osteoarthritis is superior on CT. To prevent disability of the hand, the radiologist has to provide an early and precise diagnosis. This case-based review highlights the imaging procedures suitable for detection and classification of carpal instability.
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Affiliation(s)
- Nina Hesse
- Department of Radiology, LMU, Munich, Germany
| | - Rainer Schmitt
- Department of Radiology, LMU, Munich, Germany.,Department of Radiology, University Hospital Würzburg, Würzburg, Germany
| | | | - Jan-Peter Grunz
- Department of Radiology, University Hospital Würzburg, Würzburg, Germany
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Abstract
Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called "scapholunate complex" has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).
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Huflage H, Luetkens KS, Conrads N, Jakubietz MG, Jakubietz RG, Schmitt R, Goertz L, Pennig L, Bley TA, Grunz JP. Assessing the scapholunate and lunotriquetral interosseous ligament in MR arthrography: Diagnostic advantages of paraxial reformatting. Eur J Radiol 2021; 142:109860. [PMID: 34284233 DOI: 10.1016/j.ejrad.2021.109860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The scapholunate (SLIL) and lunotriquetral interosseous ligament (LTIL) function as the main stabilizers of the proximal carpal row. Even with MR arthrography, component assessability is often limited in orthogonal standard planes due to their horseshoe-like shape and resulting partial volume effects. This study aims to investigate the diagnostic value of reformatting isotropic 3D sequences with respect to the anatomical orientation of the intrinsic carpal ligaments. METHOD In 110 MR arthrograms of the wrist, we investigated the diagnostic accuracy of two radiologists (R1/R2) for SLIL and LTIL injuries in orthogonal standard planes vs. ancillary angulated reformatting of isotropic 3D dual echo steady state sequence. Component assessability and diagnostic confidence were compared between datasets. RESULTS The addition of paraxial reformations improved diagnostic accuracy for lesions of the palmar (R1: 0.87 vs. 0.93; R2: 0.86 vs. 0.93; all p < 0.05) and dorsal LTIL (R1: 0.85 vs. 0.93; R2: 0.82 vs. 0.90; all p < 0.05). No significant increase in accuracy could be ascertained for palmar (R1: 0.92 vs. 0.94, p = 0.50; R2: 0.86 vs. 0.92, p = 0.07) and dorsal (R1: 0.95 vs. 0.95, p = 1.00; R2: 0.90 vs. 0.94, p = 0.29) lesions of the SLIL. Interrater reliability was almost perfect with and without angulated planes for SLIL (κ = 0.88 vs. 0.82) and LTIL assessment (κ = 0.88 vs. 0.86). For the LTIL, observer confidence and component assessability were superior with anatomical reformations available (all p < 0.05). CONCLUSIONS In contrast to SLIL injuries, diagnosis of LTIL lesions benefits from ancillary paraxial reformations of 3D sequences in MR wrist arthrography.
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Affiliation(s)
- Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany.
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Michael Georg Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Rafael Gregor Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany; Department of Radiology, University Hospital, LMU Munich, Marchioninistraße 15, 81377 Munich, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
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7
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Dietrich TJ, Toms AP, Cerezal L, Omoumi P, Boutin RD, Fritz J, Schmitt R, Shahabpour M, Becce F, Cotten A, Blum A, Zanetti M, Llopis E, Bień M, Lalam RK, Afonso PD, Mascarenhas VV, Sutter R, Teh J, Pracoń G, de Jonge MC, Drapé JL, Mespreuve M, Bazzocchi A, Bierry G, Dalili D, Garcia-Elias M, Atzei A, Bain GI, Mathoulin CL, Del Piñal F, Van Overstraeten L, Szabo RM, Camus EJ, Luchetti R, Chojnowski AJ, Grünert JG, Czarnecki P, Corella F, Nagy L, Yamamoto M, Golubev IO, van Schoonhoven J, Goehtz F, Klich M, Sudoł-Szopińska I. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol 2021; 31:9446-9458. [PMID: 34100996 PMCID: PMC8589813 DOI: 10.1007/s00330-021-08073-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/12/2021] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Objectives The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique. Methods Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists. Results Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available. Conclusions Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability. Key Points • Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.
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Affiliation(s)
- Tobias Johannes Dietrich
- Division of Radiology and Nuclear Medicine, Kantonsspital St. Gallen, Rorschacherstrasse 95, CH 9007, St. Gallen, Switzerland. .,Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.
| | - Andoni Paul Toms
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Luis Cerezal
- Radiology Department, DMC-Diagnóstico Médico Cantabria, Castilla 6-Bajo, 39002, Santander, Spain
| | - Patrick Omoumi
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Robert Downey Boutin
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, MC-5105, Stanford, CA, 94305, USA
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA
| | - Rainer Schmitt
- Klinikum der Ludwig-Maximilians-Universität München, Klinik und Poliklinik für Radiologie, Marchioninistraße 15, D-81377, München, Germany
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Anne Cotten
- Service de Radiologie et Imagerie Musculosquelettique, CCIAL, CHU de Lille, 59800, Lille, France
| | - Alain Blum
- Guilloz Imaging Department, Central Hospital, University Hospital Center of Nancy, UDL, 29 avenue du Maréchal de Lattre de Tassigny, 54035, Nancy, France
| | - Marco Zanetti
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Department of Musculoskeletal Radiology, Clinic Hirslanden Zurich, Witellikerstrasse 40, 8008, Zurich, Switzerland
| | - Eva Llopis
- Hospital de la Ribera, IMSKE, Valencia, Paseo Ciudadela 13, 46003, Valencia, Spain
| | - Maciej Bień
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland
| | - Radhesh Krishna Lalam
- Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.,Hospital Particular da Madeira, HPA, Funchal, Madeira, Portugal
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.,AIRC, Advanced Imaging Research Consortium, Lisbon, Portugal
| | - Reto Sutter
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Grzegorz Pracoń
- Gamma Medical Center, Broniewskiego 3, 01-785, Warsaw, Poland.,Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
| | - Milko C de Jonge
- Department of Radiology, St. Antonius Hospital Utrecht, Utrecht, The Netherlands
| | - Jean-Luc Drapé
- Service de Radiologie B, Groupe Hospitalier Cochin, AP-HP Centre, Université de Paris, 75014, Paris, France
| | - Marc Mespreuve
- Department of Medical Imaging, University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Guillaume Bierry
- MSK Imaging, University Hospital, 1 Avenue Molière, 67098, Strasbourg Cedex, France
| | - Danoob Dalili
- Epsom & St Helier University Hospitals NHS Trust Radiology Department, Dorking Road, Epsom, London, KT18 7EG, UK
| | - Marc Garcia-Elias
- Hand and Upper Extremity Surgery, Creu Blanca, P° Reina Elisenda 57, 08022, Barcelona, Spain
| | - Andrea Atzei
- Pro-Mano, Treviso, Italy and Ospedale Koelliker, Corso G. Ferraris 247, 10134, Torino, Italy
| | - Gregory Ian Bain
- Department of Orthopaedic Surgery, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | | | - Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Serrano 58 1B, 28001, Madrid, Spain
| | - Luc Van Overstraeten
- Hand and Foot Surgery Unit (HFSU) SPRL, Rue Pierre Caille 9, 7500, Tournai, Belgium.,Department of Orthopaedics and Traumatology, Erasme University Hospital, Route de Lennik, 808, Brussels, Belgium
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California Davis, Health System, 4800 Y Street, Sacramento, CA, 95817, USA
| | - Emmanuel J Camus
- Hand Surgery Unit, Clinique de Lille Sud, 96 Rue Gustave Delory, Lesquin, France
| | | | - Adrian Julian Chojnowski
- Orthopaedics and Trauma Department, Hand and Upper Limb Surgery, Norfolk and Norwich University NHS Trust Hospital, Colney Lane, Norwich, NR4 7UY, UK
| | - Jörg G Grünert
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Piotr Czarnecki
- Traumatology, Orthopaedics and Hand Surgery Department, Poznan University of Medical Sciences, ul. 28 Czerwca 1956r. nr 135/147, 61-545, Poznań, Poland
| | - Fernando Corella
- Orthopedic and Trauma Department, Hospital Universitario Infanta Leonor, C/ Gran Vía del Este N° 80, 28031, Madrid, Spain.,Hand Surgery Unit, Hospital Universitario Quirónsalud Madrid, Madrid, Spain.,Surgery Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Ladislav Nagy
- Faculty of Medicine, University of Zurich, Pestalozzistrasse 3, 8091, Zurich, Switzerland.,Division for Hand Surgery and Surgery of Peripheral Nerves, Balgrist University Hospital, University of Zurich, Forchstrasse, 340, 8008, Zurich, Switzerland
| | - Michiro Yamamoto
- Department of Hand Surgery, Nagoya University, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Igor O Golubev
- Hand and Microsurgery Division, National Medical Research Centre of Traumatology and Orthopaedic named after N.N. Priorov, Moscow, Russia
| | - Jörg van Schoonhoven
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Florian Goehtz
- Clinic for Hand Surgery, Rhön Medical Center, Campus Bad Neustadt, Von Guttenberg-Straße 11, 97616, Bad Neustadt/Saale, Germany
| | - Maciej Klich
- Department of Traumatology and Orthopaedics, Postgraduate Medical Center, A. Gruca Teaching Hospital, Otwock, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Spartańska 1, 02-637, Warsaw, Poland
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Huflage H, Luetkens KS, Kunz AS, Conrads N, Jakubietz RG, Jakubietz MG, Pennig L, Goertz L, Bley TA, Schmitt R, Grunz JP. Improved diagnostic accuracy for ulnar-sided TFCC lesions with radial reformation of 3D sequences in wrist MR arthrography. Eur Radiol 2021; 31:9399-9407. [PMID: 34003353 PMCID: PMC8589820 DOI: 10.1007/s00330-021-08024-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 03/30/2021] [Accepted: 04/27/2021] [Indexed: 01/06/2023]
Abstract
Objectives Triangular fibrocartilage complex (TFCC) injuries frequently cause ulnar-sided wrist pain and can induce distal radioulnar joint instability. With its complex three-dimensional structure, diagnosis of TFCC lesions remains a challenging task even in MR arthrograms. The aim of this study was to assess the added diagnostic value of radial reformatting of isotropic 3D MRI datasets compared to standard planes after direct arthrography of the wrist. Methods Ninety-three patients underwent wrist MRI after fluoroscopy-guided multi-compartment arthrography. Two radiologists collectively analyzed two datasets of each MR arthrogram for TFCC injuries, with one set containing standard reconstructions of a 3D thin-slice sequence in axial, coronal and sagittal orientation, while the other set comprised an additional radial plane view with the rotating center positioned at the ulnar styloid. Surgical reports (whenever available) or radiological reports combined with clinical follow-up served as a standard of reference. In addition, diagnostic confidence and assessability of the central disc and ulnar-sided insertions were subjectively evaluated. Results Injuries of the articular disc, styloid and foveal ulnar attachment were present in 20 (23.7%), 10 (10.8%) and 9 (9.7%) patients. Additional radial planes increased diagnostic accuracy for lesions of the styloid (0.83 vs. 0.90; p = 0.016) and foveal (0.86 vs. 0.94; p = 0.039) insertion, whereas no improvement was identified for alterations of the central cartilage disc. Readers’ confidence (p < 0.001) and assessability of the ulnar-sided insertions (p < 0.001) were superior with ancillary radial reformatting. Conclusions Access to the radial plane view of isotropic 3D sequences in MR arthrography improves diagnostic accuracy and confidence for ulnar-sided TFCC lesions. Key Points • In multi-compartment arthrography of the wrist, ancillary radial plane view aids assessability of the foveal and styloid ulnar-sided insertions of the triangular fibrocartilage complex. • Assessment of peripheral TFCC injuries is more accurate with access to radial multiplanar reconstructions. • Additional radial planes provide greater diagnostic confidence.
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Affiliation(s)
- Henner Huflage
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.
| | - Karsten Sebastian Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Andreas Steven Kunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Nora Conrads
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rafael Gregor Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Michael Georg Jakubietz
- Department of Trauma-, Hand-, Plastic- and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany.,Department of Radiology, University Hospital LMU Munich, Marchioninistrasse 15, 81377, Munich, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Germany
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9
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Athlani L, Pauchard N, Dautel G. Intercarpal ligamentoplasty for scapholunate dissociation: comparison of two techniques. J Hand Surg Eur Vol 2021; 46:278-285. [PMID: 32686557 DOI: 10.1177/1753193420940498] [Citation(s) in RCA: 3] [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
We modified our original surgical technique of scapholunate intercarpal ligamentoplasty for treating chronic scapholunate dissociation. The aim of this study was to compare the outcomes in patients treated by the same surgical team with the original method and the modified method over two different time periods. Nineteen patients with a mean age of 40 years were treated with the original method (mean follow-up of 34 months, range 12-54), and 21 patients with a mean age of 38 years were treated with the modified method (mean follow-up of 27 months, range 13-40). In both groups, we found a significant improvement in pain levels, grip strength, functional scores in terms of QuickDASH and Patient-Rated Wrist Evaluation, and radiographic scapholunate gap and scapholunate angle after surgery. There were no significant differences between the two groups in outcome measures except the scapholunate gap, which was significantly better controlled by the modified procedure. Between the immediate postoperative period and the last follow-up, there was a significant increase in the scapholunate gap and scapholunate angle after the original method, while there only a small increase after the modified method. We conclude that both versions of the scapholunate intercarpal ligamentoplasty yield satisfactory clinical and radiological results in the short to mid-term. The modified method makes the triquetral surgical step easier and seems to better optimize the tension across the ligamentoplasty, thus maintaining the intercarpal correction.Level of evidence: III.
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Affiliation(s)
- Lionel Athlani
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
| | - Nicolas Pauchard
- Service de Chirurgie de la Main - SOS main. Hôpital Privé Dijon Bourgogne, France
| | - Gilles Dautel
- Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, CHU Nancy, France
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Evaluation of Dorsal Scaphoid Displacement Using Posterior Radioscaphoid Angle in Patients With Suspected Scapholunate Instability: A Preliminary Study. J Hand Surg Am 2021; 46:10-16. [PMID: 33191036 DOI: 10.1016/j.jhsa.2020.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the validity and reliability of the posterior radioscaphoid angle (PRSA), an indicator of dorsal displacement of the scaphoid, in distinguishing wrists with and without chronic scapholunate instability (SLI). METHODS We prospectively evaluated 40 patients (22 men and 18 women; mean age, 46 ± 13 years) with suspected SLI with radiographs and computed tomography arthrography. Based on these data, 3 groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). An independent reader measured the PRSA on sagittal computed tomography images using the same procedure. RESULTS The PRSA median values were significantly lower in the negative SLI group (98°) compared with the positive SLI (110°) and questionable SLI (111°) groups. The difference between the positive SLI and questionable SLI groups was not significant. The best differentiation between patients with and without SLI was obtained with a PRSA threshold value of 103° (specificity of 86% and sensitivity of 79%). CONCLUSIONS In this preliminary study, PRSA analysis offers a quantitative tool for the evaluation of dorsal scaphoid displacement in cases of SLI, including for patients presenting with questionable initial radiography findings. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
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11
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Grunz JP, Gietzen CH, Grunz K, Bley T, Schmitt R. Imaging of Carpal Instabilities. ROFO-FORTSCHR RONTG 2020; 193:139-150. [DOI: 10.1055/a-1219-8158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The term “carpal instability” describes different debilitating wrist conditions, in which the carpus is unable to maintain its physiological range of motion and load transfer. Depending on the cause and location of the dysfunction, four groups can be defined: dissociative, non-dissociative, complex, and adaptive carpal instability. As the most common form by far, dissociative carpal instability can further be categorized as dorsal or palmar intercalated segment instability, contingent on the afflicted interosseous ligament.Method This review article outlines the different entities of carpal instability, their pathophysiology, and their clinical presentation. It further discusses the diagnostic significance of different imaging methods as well as the established treatment options for each form of instability in context with the current literature.Results and Conclusion Early detection and treatment of carpal instability are essential for preventing carpal osteoarthritis. Traumatic lesions of the scapholunate interosseous ligament are the most frequent cause of instability. They can occur in an isolated fashion or in context with other carpal injuries. While stress imaging and fluoroscopy facilitate the differentiation between dynamic and static forms of carpal instability, only MRI and CT/MR arthrography can directly reveal the extent of ligament discontinuity.Key Points:Citation Format
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Katharina Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Thorsten Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Germany
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12
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Grunz JP, Gietzen CH, Luetkens K, Wagner M, Kalb K, Bley TA, Lehmkuhl L, van Schoonhoven J, Gassenmaier T, Schmitt R. The importance of radial multiplanar reconstructions for assessment of triangular fibrocartilage complex injury in CT arthrography of the wrist. BMC Musculoskelet Disord 2020; 21:286. [PMID: 32381000 PMCID: PMC7206688 DOI: 10.1186/s12891-020-03321-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Triangular fibrocartilage complex (TFCC) lesions commonly cause ulnar-sided wrist pain and instability of the distal radioulnar joint. Due to its triangular shape, discontinuity of the TFCC is oftentimes difficult to visualize in radiological standard planes. Radial multiplanar reconstructions (MPR) may have the potential to simplify diagnosis in CT wrist arthrography. The objective of this study was to assess diagnostic advantages provided by radial MPR over standard planes for TFCC lesions in CT arthrography. Methods One hundred six patients (49 women, 57 men; mean age 44.2 ± 15.8 years) underwent CT imaging after wrist arthrography. Two radiologists (R1, R2) retrospectively analyzed three randomized datasets for each CT arthrography. One set contained axial, coronal and sagittal planes (MPRStandard), while the other two included an additional radial reconstruction with the rotating center either atop the ulnar styloid (MPRStyloid) or in the ulnar fovea (MPRFovea). Readers evaluated TFCC differentiability and condition. Suspected lesions were categorized using Palmer’s and Atzei’s classification and diagnostic confidence was stated on a five-point Likert scale. Results Compared to standard planes, differentiability of the superficial and deep TFCC layer was superior in radial reconstructions (R1/R2; MPRFovea: p < 0.001; MPRStyloid: p ≤ 0.007). Palmer and Atzei lesions were present in 86.8% (92/106) and 52.8% (56/106) of patients, respectively. Specificity, sensitivity and accuracy for central Palmer lesions did not differ in radial and standard MPR. For peripheral Atzei lesions, sensitivity (MPRStandard 78.6%/80.4%, MPRStyloid 94.6%/94.6%, MPRFovea 91.1%/89.3%) and accuracy (MPRStandard 86.8%/86.8%, MPRStyloid 96.2%/96.2%, MPRFovea 94.3%/93.4%) improved with additional styloid-centered (p = 0.004/0.008) and fovea-centered (p = 0.039/0.125) reconstructions. No substantial difference was observed between both radial MPR (p = 0.688/0.250). Interrater agreement was almost perfect for each dataset (κStandard = 0.876, κStyloid = 0.894, κFovea = 0.949). Diagnostic confidence increased with addition of either radial MPR (p < 0.001). Conclusions Ancillary radial planes improve accuracy and diagnostic confidence for detection of peripheral TFCC lesions in CT arthrography of the wrist.
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Affiliation(s)
- Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany. .,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Carsten Herbert Gietzen
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Karsten Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Matthias Wagner
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Karlheinz Kalb
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Thorsten Alexander Bley
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Lukas Lehmkuhl
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Jörg van Schoonhoven
- Department of Hand Surgery, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Rainer Schmitt
- Department of Diagnostic and Interventional Radiology, Rhön-Klinikum Campus Bad Neustadt, Von-Guttenberg-Str. 11, 97616, Bad Neustadt an der Saale, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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13
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Quere JB, Phan C, Miquel A, Li L, Arrivé L, Menu Y, Crema MD. MDCT arthrography assessment of the severity of cartilage damage and scapholunate dissociation in regard to specific-component tears of the scapholunate interosseous ligament. Eur J Radiol 2020; 125:108901. [DOI: 10.1016/j.ejrad.2020.108901] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
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14
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Borgese M, Boutin RD, Bayne CO, Szabo RM, Chaudhari AJ. Association of lunate morphology, sex, and lunotriquetral interosseous ligament injury with radiologic measurement of the capitate-triquetrum joint. Skeletal Radiol 2017; 46:1729-1737. [PMID: 28828602 PMCID: PMC5710747 DOI: 10.1007/s00256-017-2747-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/30/2017] [Accepted: 08/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Radiologic presentation of carpal instability at the radial side of the carpus, e.g. scapholunate diastasis following scapholunate interosseous ligament injury, has been studied extensively. By comparison, presentation at the ulnar-sided carpus has not. The purpose of this study was to assess the effects of lunate morphology, sex, and lunotriquetral interosseous ligament (LTIL) status on the radiologic measurement of the capitate-triquetrum joint (C-T distance). Further, we sought to evaluate the diagnostic accuracy of C-T distance for assessing LTIL injuries. MATERIALS AND METHODS We retrospectively identified 223 wrists with wrist radiographs and MR arthrograms with contrast injection. Data collected included sex, lunate morphology and LTIL status from MR arthrography, and C-T distance from radiography. The effects of lunate morphology, sex, and LTIL injury status on C-T distance were evaluated using generalized linear models. Diagnostic performance of C-T distance was assessed by the area under receiver-operator characteristic curve (AUROC). RESULTS AND CONCLUSION Lunate morphology, sex, and LTIL injury status all had significant effects on C-T distance; wrists with type II lunates, men, and wrists with LTIL injuries had greater C-T distances than wrists with type I lunates, women, and wrists without LTIL injuries, respectively (p < 0.01). The diagnostic value of the C-T distance for identifying patients with full-thickness LTIL tears was sufficient for women with type I (AUROC = 0.67) and type II lunates (0.60) and good for men with type I (0.72) and type II lunates (0.77). The demonstrated influence of LTIL status on C-T distance supports the use of C-T distance as a tool in assessing for full-thickness LTIL tears.
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Affiliation(s)
- Marissa Borgese
- Department of Radiology, University of California - Davis, Sacramento, CA, 95817, USA
| | - Robert D Boutin
- Department of Radiology, University of California - Davis, Sacramento, CA, 95817, USA
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California - Davis, Sacramento, CA, 95817, USA
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California - Davis, Sacramento, CA, 95817, USA
| | - Abhijit J Chaudhari
- Department of Radiology, University of California - Davis, Sacramento, CA, 95817, USA.
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15
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Hernández M, Montoya F, Gutiérrez M, Cereceda B. Inestabilidad lunopiramidal. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2017. [DOI: 10.1016/j.ricma.2016.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Históricamente, la inestabilidad en el lado radial de la muñeca ha recibido mucha más atención que la inestabilidad en el lado ulnar, a pesar de ser una patología relativamente frecuente. Como consecuencia de ello, suele darse un retraso en el diagnóstico correcto y el tratamiento apropiado. Las lesiones del ligamento lunopiramidal pueden ser parciales o completas, y estas últimas pueden estar asociadas a lesión de los estabilizadores secundarios. Cuando se lesionan estos estabilizadores es cuando se produce una inestabilidad estática del carpo conocida como Volar Intercalated Segmentary Instability (VISI). Entre los test clínicos más utilizados para detectar una inestabilidad del ligamento lunopiramidal están el Ballottement test, descrito por Reagan, y el Shear test, descrito por Kleinman, aunque ambos poseen una sensibilidad y una especificidad bajas. Para el diagnóstico de estas lesiones se emplean técnicas como la radiografía simple (que suele ser normal si no hay una inestabilidad estática del carpo), la artrografía y la RMN, entre otras, aunque el gold standard lo constituye la artroscopia de muñeca. No existe un consenso en cuanto al tipo de tratamiento óptimo, ya que la mayoría de los estudios publicados son retrospectivos de nivel iv sin medidas objetivas estandarizadas mediante instrumentos validados. Además, en su mayoría describen los resultados del tratamiento tardío, ya que no se suelen diagnosticar en la fase aguda. Dentro de los tratamientos descritos se encuentran el tratamiento artroscópico (desbridamiento/termocoagulación asociados o no a estabilización con agujas de Kirscher), la reparación abierta, la reconstrucción del ligamento y la artrodesis del ligamento lunopiramidal.
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Affiliation(s)
- M. Hernández
- Hospital Universitario Infanta Leonor, Madrid, España
- Unidad de Cirugía de Mano, Hospital Beata María Ana, Madrid, España
| | - F. Montoya
- Hospital Universitario Infanta Leonor, Madrid, España
- Unidad de Cirugía de Mano, Hospital Beata María Ana, Madrid, España
| | - M. Gutiérrez
- Unidad de Cirugía de Mano, Hospital Beata María Ana, Madrid, España
| | - B. Cereceda
- Hospital Universitario Infanta Leonor, Madrid, España
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