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Haeberle HS, DeFrancesco CJ, Yang BW, Victoria C, Wolfe SW. One-Year Outcomes of the Anatomical Front and Back Reconstruction for Scapholunate Dissociation. J Hand Surg Am 2024; 49:329-336. [PMID: 38244024 DOI: 10.1016/j.jhsa.2023.12.012] [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] [Received: 04/17/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/22/2024]
Abstract
PURPOSE Anatomical front and back (ANAFAB) reconstruction addresses the critical volar and dorsal ligaments associated with scapholunate dissociation. We hypothesized that patients with symptomatic, chronic, late-stage scapholunate dissociation would demonstrate improvements in all radiographic parameters and patient-reported outcomes (PROMs) after ANAFAB reconstruction. METHODS From 2018 to 2021, 21 ANAFAB reconstructions performed by a single surgeon were followed prospectively, with 20 patients having a minimum follow-up of 12 months. In total, 17 men and four women were included, with an average age of 49 years. Three patients had modified Garcia-Elias stage 3 disease, eight stage 4, seven stage 5, and three stage 7. ANAFAB reconstruction of intrinsic and extrinsic ligament stabilizers was performed using a hybrid synthetic tape/tendon graft in a transosseous reconstruction. Pre- and postoperative radiographic parameters, grip, pinch strength, the Patient-Rated Wrist Evaluation, PROMIS Upper Extremity Function, and PROMIS Pain Interference outcome measures were compared. RESULTS Mean follow-up was 17.9 months (range: 12-38). Radiographic parameters were improved at follow-up, including the following: scapholunate angle (mean 75.3° preoperatively to 69.2°), scapholunate gap (5.9-4.2 mm), dorsal scaphoid translation (1.2-0.2 mm), and radiolunate angle (13.5° to 1.8°). Mean Patient-Rated Wrist Evaluation scores for pain and function decreased from 40.6 before surgery to 10.4. We were unable to detect a significant difference in grip or pinch strength or radioscaphoid angle with the numbers tested. There were two minor complications, and two complications required re-operations, one patient who was converted to a proximal row carpectomy for failure of fixation, and one who required tenolysis/arthrolysis for arthrofibrosis. CONCLUSIONS At 17.9-month average follow-up, radiographic and patient-reported outcome parameters improved after reconstruction of the critical dorsal and volar ligament stabilizers of the proximal carpal row with the ANAFAB technique. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Heather S Haeberle
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Christopher J DeFrancesco
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Brian W Yang
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Christian Victoria
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Scott W Wolfe
- Hand and Upper Extremity Service, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.
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Yang BW, Victoria C, Lee SK, Wolfe SW. Anatomical front and back reconstruction sustains radiographic alignment: a comparison to three-ligament tenodesis. J Hand Surg Eur Vol 2024; 49:60-65. [PMID: 37751490 DOI: 10.1177/17531934231192343] [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: 09/28/2023]
Abstract
Multiple techniques exist to reconstruct the scapholunate interosseous ligament, though none have demonstrated superiority. This study compares 1-year radiographic outcomes of the three-ligament tenodesis and the anatomical front and back reconstruction. All patients who underwent reconstruction of their scapholunate interosseous ligament at one institution with either anatomical front and back reconstruction or three-ligament tenodesis between 2011 and 2020 were retrospectively reviewed. At 52-week follow-up, anatomical front and back reconstruction maintained a statistically significant improvement in scapholunate gap, corrected radiolunate angle and dorsal scaphoid translation, while three-ligament tenodesis demonstrated no sustained improvement in any parameter. The improvement in dorsal scaphoid translation was significantly greater for patients undergoing anatomical front and back reconstruction compared with three-ligament tenodesis at the 16-weeks postoperative timepoint (-1.0 mm, -0.3 mm). Anatomical front and back reconstruction demonstrates sustained improvement in radiographic outcomes at 1 year when compared with three-ligament tenodesis. By addressing both volar and dorsal critical ligament restraints, adoption of anatomical front and back reconstruction for advanced stage scapholunate interosseous ligament injuries should be considered.Level of evidence: IV.
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Wessel LE, Wolfe SW. Scapholunate Instability: Diagnosis and Management - Classification and Treatment Considerations - Part 2. J Hand Surg Am 2023; 48:1252-1262. [PMID: 37578401 DOI: 10.1016/j.jhsa.2023.06.016] [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] [Received: 12/30/2022] [Revised: 03/22/2023] [Accepted: 06/21/2023] [Indexed: 08/15/2023]
Abstract
Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this Current Concepts article reviewed the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical stabilizers. In this section, we provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. These updates clarify the importance of the critical stabilizers of the scapholunate interval, ligament-specific considerations in scapholunate ligament reconstruction, and the risks of ligament disinsertion when surgically exposing the dorsal wrist. We propose a ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
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Affiliation(s)
| | - Scott W Wolfe
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
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Lee YC, Shih YC, Lo IN, Shih JT. Arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor in acute and subacute scapholunate dissociation. J Orthop Surg Res 2023; 18:661. [PMID: 37670343 PMCID: PMC10481611 DOI: 10.1186/s13018-023-04148-y] [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] [Received: 04/18/2023] [Accepted: 08/29/2023] [Indexed: 09/07/2023] Open
Abstract
PURPOSE The objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability. METHODS From Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4-11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24-32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period. RESULTS All 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion-extension plane loss averaged 5.1° (P > .01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P < .01); the postoperative MMWS was significantly better than the preoperative scores (P < .01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up. CONCLUSIONS At a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Yu-Cheng Lee
- Department of Orthopedic Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, 300, Taiwan
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Yin-Chuan Shih
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Department of Orthopedic Surgery, En Chu Kong Hospital, New Taipei City, Taiwan
- Department of Orthopedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - I-Ning Lo
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, 112, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Jui-Tien Shih
- Department of Orthopedic Surgery Centre for Sports Medicine Armed Forces Taoyuan General Hospital, 168, Zhongxing Rd., Longtan, Taoyuan, 325, Taiwan.
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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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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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Werner FW. Design Requirements for Scapholunate Interosseous Ligament Reconstruction. J Wrist Surg 2021; 10:484-491. [PMID: 34881103 PMCID: PMC8635823 DOI: 10.1055/s-0041-1728802] [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: 08/21/2020] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Background As numerous repairs, reconstructions, and replacements have been used following scapholunate interosseous ligament (SLIL) injury, there is a need to define the structural requirements for any reconstruction or replacement. Methods Research has been conducted on the force needed to keep the scaphoid and lunate reduced following simulated injury, the failure force of the native SLIL and various replacements, the stiffness of the SLIL and replacements, and the torsional resistance of the scaphoid relative to the lunate. Results Forces on the order of 50 N are needed to keep the scaphoid and lunate reduced during simple wrist motions in the chronically injured wrist. Even greater forces (up to 110 N) are needed to keep the bones reduced during strenuous activities, such as pushups. The failure force of the entire SLIL has been reported to be as high as 350 N and the failure force of just the dorsal component of the SLIL to be 270 N. Conclusions The design requirements for a reconstruction or repair may vary depending upon the demands of the patient. In a high demand patient, a reconstruction needs to support the above-mentioned forces during cyclic loading (50 N), when performing strenuous activities (110 N), or during a fall (at least 350 N). Any artificial replacement must undergo careful biocompatibility testing.
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Affiliation(s)
- Frederick W. Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
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Kang SH, Chae S, Kim J, Lee J, Park IJ. Scapholunate and lunotriquetral interosseous ligament augmentation with internal bracing in perilunate dislocation: Case reports. Medicine (Baltimore) 2021; 100:e26827. [PMID: 34559095 PMCID: PMC8462623 DOI: 10.1097/md.0000000000026827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/19/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The goals of surgical treatment of the perilunate dislocation (PLD) are confirmation of reduction, ligament repair, and supplemental fixation of the bony architecture. Open reduction and direct repair of the torn ligament are recommended for acute PLD. However, repair of the scapholunate interosseous ligament (SLIL) and lunotriquetral interosseous ligament (LTIL) is often unreliable, and secure repair is challenging. Internal bracing (IB) is an augmentation method that uses high-strength non-absorbable tape and enhances strength and support during the critical period of ligamentous healing. However, there is a paucity of data on the application of IB for PLD in the wrist. We report 3 cases of PLD that were augmented with IB after SLIL and LTIL repair. PATIENT CONCERNS All 3 cases were men who visited our emergency department with wrist after falling off a ladder. DIAGNOSES Initial radiographs revealed a dorsal PLD. INTERVENTIONS Surgically, complete rupture of the SLIL and LTIL were confirmed. K-wires were placed into the scaphoid and lunate and used as joysticks to correct the intercalated segment instability pattern. This usually requires correcting scaphoid flexion and lunate extension and closing the scapholunate interval. Prior to SLIL and LTIL repair, temporary intercarpal fixation was performed with K-wires to maintain the carpal relationship. The dorsal SLIL and LTIL were carefully repaired using suture anchors. However, ligament repair was unreliable, and insecure. In view of the likelihood of insufficient repair, we performed IB augmentation using synthetic tape. OUTCOMES At the last follow-up, all cases were pain-free and had returned to all activities. The last follow-up radiographs showed good alignment of the carpal bones and no arthritic changes. LESSONS IB augmentation can reduce the period of K-wire fixation and cast immobilization and can enable early joint motion. We believe that interosseous ligament augmentation using IB is a reasonable treatment option for PLD.
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Affiliation(s)
- Soo-Hwan Kang
- Department of Orthopaedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbum Chae
- Department of Orthopaedic Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Deagu, Republic of Korea
| | - Jongmin Kim
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiwon Lee
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Il-Jung Park
- Department of Orthopaedic Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Moneim MS, Aubin-Lemay C, Anderson MS, Mercer DM. Long-term Outcomes of Delayed Scapholunate Ligament Repair After Complete Rupture of the Ligament. Orthopedics 2021; 44:e446-e453. [PMID: 34039212 DOI: 10.3928/01477447-20210415-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Treatment of isolated complete tear of the scapholunate ligament is challenging. The purpose of this study was to determine (1) whether delayed repair of only scapholunate ligament is an option without other reconstruction procedures and (2) whether functional outcomes are possible despite radiographic presence of arthritis. This study included patients who had complete ligament tear at exploration and underwent only scapholunate ligament repair without capsulodesis or tenodesis. Fifteen patients returned for clinical and radiographic examinations. Preoperatively, mean scapholunate gap was 2.9 mm and 4.58 mm on posteroanterior and tangential posteroanterior views, respectively. Postoperatively, the final mean gap was 2.5 mm and 3.9 mm on the posteroanterior and tangential posteroanterior views, respectively. The mean preoperative and final scapholunate angles were 74° and 72.6°, respectively. Seven patients had radiographic arthritis at final follow-up. Delayed scapholunate repair is possible after complete ligament tear. At long-term follow-up, clinical functional outcomes may not correlate with radiographic presence of degenerative arthritis. [Orthopedics. 2021;44(3):e446-e453.].
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Zeiderman MR, Sonoda LA, McNary S, Asselin E, Boutin RD, Bayne CO, Szabo RM. The Biomechanical Effects of Augmentation With Flat Braided Suture on Dorsal Intercarpal Ligament Capsulodesis for Scapholunate Instability. J Hand Surg Am 2021; 46:517.e1-517.e9. [PMID: 33423852 DOI: 10.1016/j.jhsa.2020.10.032] [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: 02/09/2020] [Revised: 08/29/2020] [Accepted: 10/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Selecting treatment for scapholunate (SL) instability is notoriously difficult. Many methods of reconstruction have been described, but no procedure demonstrates clear superiority. New methods proposed use internal bracing (IB) with suture anchors and flat braided suture (FBS), alone or as an augmentation with tendon autograft for SL ligament injuries. Our goal was to use computed tomography (CT) to analyze alignment of the SL joint after 3 different modes of fixation of SL instability: after reconstruction with IB incorporating either tendon autograft or the dorsal intercarpal ligament (DICL), or DICL capsulodesis without FBS. METHODS Ten fresh-frozen, matched-pair, forearm-to-hand specimens were used. Serial sectioning of the SL stabilizing ligaments was performed and the SL interval was measured with CT. We reconstructed the SL ligament with DICL capsulodesis alone (DICL) or with IB augmented with either tendon autograft (IB plus T) or DICL (DICL plus IB). The SL interval was measured with CT. Specimens underwent 500 weighted cycles on a jig and were reimaged. Differences in SL interval after repair and cycling were compared. RESULTS Dorsal intercarpal ligament capsulodesis augmented with IB best maintained the SL interval before and after cycling. Dorsal intercarpal ligament capsulodesis alone was inferior to DICL plus IB and IB plus T both before and after cycling. CONCLUSIONS Dorsal intercarpal ligament capsulodesis augmented with IB appears to maintain better SL joint reduction than IB with tendon autograft. CLINICAL RELEVANCE This work serves as a necessary step for further study of the biomechanical strength and clinical application of FBS technology in the reconstruction of SL instability. Flat braided suture augmentation of DICL capsulodesis may provide another option to consider for reconstruction of SL instability.
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Affiliation(s)
- Matthew R Zeiderman
- Department of Orthopaedic Surgery; Department of Surgery, Division of Plastic and Reconstructive Surgery.
| | | | | | | | - Robert D Boutin
- Department of Radiology, Davis School of Medicine, University of California, Sacramento, CA
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Calfee RP, Antes AL, Rozental TD, Goldfarb CA, Wolf JM, Levin LS, Chung KC. Applying the Delphi Method to Define a Focus for the National Outcomes Registry for Tracking the Hand (NORTH). J Hand Surg Am 2021; 46:417-420. [PMID: 33722474 DOI: 10.1016/j.jhsa.2021.01.007] [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: 10/21/2020] [Accepted: 01/18/2021] [Indexed: 02/02/2023]
Abstract
Surgical registries have provided reliable, generalizable, and applicable clinical data that have shaped many fields. Broad collection of defined data can answer clinical questions with greater numbers of patients and more ability to generalize to routine clinical care than randomized trials. National hand surgical registries exist outside the United States. Before the pursuit of a registry, the focus of such an effort must be defined to ensure that registry goals are feasible. This article presents the consensus process conducted by the American Society for Surgery of the Hand's Registry Task Force exploring potential diagnoses for a hand registry.
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Affiliation(s)
- Ryan P Calfee
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO.
| | - Alison L Antes
- Division of General Medical Sciences, Washington University School of Medicine, St Louis, MO
| | - Tamara D Rozental
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Charles A Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, MO
| | - Jennifer M Wolf
- Department of Orthopaedic Surgery, University of Chicago School of Medicine, Chicago, IL
| | - L Scott Levin
- Department of Orthopaedic Surgery, Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Surgery, Division of Plastic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Kevin C Chung
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan, Ann Arbor, MI
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12
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Thompson RG, Dustin JA, Roper DK, Kane SM, Lourie GM. Suture Tape Augmentation for Scapholunate Ligament Repair: A Biomechanical Study. J Hand Surg Am 2021; 46:36-42. [PMID: 32811693 DOI: 10.1016/j.jhsa.2020.06.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 05/10/2020] [Accepted: 06/30/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Scapholunate (SL) ligament tears in the acute setting can be treated by primary repair through various techniques. The purpose of this study was to compare repair of the SL ligament with suture anchors alone versus repair of the SL ligament augmented with suture tape. METHODS Twelve fresh-frozen cadavers (6 matched pairs) underwent a dorsal approach to the wrist and the SL ligament was sharply dissected off of its scaphoid attachment. Six cadavers underwent direct repair of the SL ligament using 2 suture anchors. The other 6 underwent repair of the SL ligament, which was then augmented with suture tape. All specimens then underwent load to failure testing using tensile distraction forces applied by a universal testing system. Maximum load to failure and mode of failure were recorded. RESULTS Maximum load to failure (135 N; SD, 44.94 N) for specimens that were repaired and augmented with the internal brace was higher than that for specimens in the repair-only group (68 N; SD, 14.69 N). CONCLUSIONS Biomechanical testing demonstrated a higher maximum load to failure in SL ligament repairs augmented with suture tape compared with a repair-only technique in this cadaveric model. CLINICAL RELEVANCE Acute SL ligament injuries may benefit from suture tape augmentation by increasing the stability of the primary repair. This may prove to be beneficial in higher-demand patients.
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Affiliation(s)
- R Gil Thompson
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA.
| | - Joel A Dustin
- Department of Biological Engineering, Utah State University, Logan, UT
| | - D Keith Roper
- Department of Biological Engineering, Utah State University, Logan, UT
| | - Steven M Kane
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA
| | - Gary M Lourie
- Department of Orthopedic Surgery, Wellstar Atlanta Medical Center, Atlanta, GA; The Hand and Upper Extremity Center of Georgia, Atlanta, GA
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Haug LCP, Adler T, Bignion D, Voegelin E. Radio-luno-triquetral bone-ligament transfer as an additional stabilizer in scapholunate-instability. Arch Orthop Trauma Surg 2021; 141:341-347. [PMID: 33251560 PMCID: PMC7886774 DOI: 10.1007/s00402-020-03690-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Reconstruction of the scapho-lunate (SL) ligament is still challenging. Many different techniques, such as capsulodesis, tendon graft and bone-ligament-bone graft have been described to stabilize reducible SL dissociation. If primary ligament repair alone is not possible, an additional stabilizer is needed to achieve scapho-lunate stability. A new local bone-ligament transfer using half of the radio-luno-triquetral ligament is performed. The direction of traction of the transposed ligament is very similar to the original ligament. Ideal tension can be attained by fixation of the bone block at the dorsal ridge of the scaphoid. The biomechanical stability of this bone-ligament transfer shall be examined biomechanically. MATERIAL AND METHODS Computed tomography imaging was performed using eight cadaveric forearms with a defined position of the wrist. Axial load was accomplished with tension springs attached to the extensor and flexor tendons. Three series ([a] native, [b] divided SL ligament and [c]) after reconstruction with bone-ligament transfer] were reconstructed three-dimensionally to determine the angles between radius, scaphoid and lunate. The radial distal part including a bone fragment of the radio-luno-triquetral ligament was transferred from its insertion at the distal edge of the radius to be attached to the dorsal ridge of the scaphoid. RESULTS SL gap was widened after its transection. Average SL distance was 6.6 ± 1.6 mm. After ligament reconstruction, the gap could be narrowed significantly to 4.2 mm (± 0.7 mm). The movement of the scaphoid and lunate showed significant changes, especially in wrist flexion, fist closure and radial deviation. These deviations could be corrected by the bone ligament transfer. CONCLUSION Reconstruction of a transected SL ligament with a bone-ligament transfer from the radio-luno-triquetral ligament reduces SL dissociation under axial load. The described surgical technique causes low donor-side morbidity and can be considered in addition to improve stability if SL ligament suture alone does not appear sufficient. LEVEL OF EVIDENCE Level II, therapeutic investigating experimental study.
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Affiliation(s)
- Luzian C. P. Haug
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
| | - Tom Adler
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
| | - Dietmar Bignion
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
| | - Esther Voegelin
- grid.411656.10000 0004 0479 0855Department of Hand Surgery, University Hospital of Bern, 3010 Bern, Switzerland
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14
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Vutescu ES, Wolfe SW, Sung K, Jethanandani R, Lee SK. Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction. J Wrist Surg 2020; 9:487-492. [PMID: 33282534 PMCID: PMC7708033 DOI: 10.1055/s-0040-1713656] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 05/13/2020] [Indexed: 10/23/2022]
Abstract
Background Dorsal scaphoid translation (DST) has been demonstrated to occur in patients with complete scapholunate interosseous ligament (SLIL) tears. Radiographs and magnetic resonance imaging (MRI) have demonstrated ability to detect DST in patients with documented complete scapholunate (SL) disruption, but the relevance of this parameter to outcomes of reconstruction has not been determined. Purpose The purpose of this article is to determine how radiographic parameters of SL dissociation correlate with postoperative pain and functional outcomes of SLIL reconstruction. Methods We performed a retrospective review of prospectively collected data on a cohort of 14 patients who underwent SLIL repair or reconstruction. Preoperative data included radiographic measurements of carpal posture and alignment (SL angle, radiolunate [RL] angle, SL gap, and DST), self-reported measure of average pain on a numerical rating scale (NRS) of 0 to 10, and the patient rated wrist evaluation (PRWE) survey. Postoperatively, the same data were collected at each follow-up visit. Radiographic parameters were statistically compared with postoperative NRS pain score and PRWE scores. Statistical correlations were calculated using Spearman's correlation coefficient, and mean NRS pain scores were compared using Wilcoxon's rank-sum tests, with an α value of p = 0.05. Results Mean NRS pain scores improved significantly after surgery. Mean DST improved significantly after surgery. The presence of postoperative dorsal scaphoid translation (DST) correlated strongly with postoperative pain. SL angle, RL angle, and SL gap showed no correlation with patient reported pain. There was no correlation with any radiographic parameter and PRWE. Conclusions Our study demonstrates that the presence of DST in postoperative radiographs has a strong correlation with patient reported pain following SLIL reconstruction. We conclude that correction of dorsal translation of the scaphoid is a more sensitive predictor of postoperative pain relief than SL gap, RL angle, or SL angle. Level of evidence This is a Level IV study.
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Affiliation(s)
- Emil S. Vutescu
- Department of Orthopedic Surgery, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Scott W. Wolfe
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, New York
| | - Kevin Sung
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, New York
| | - Rishabh Jethanandani
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, New York
| | - Steve K. Lee
- Department of Orthopedic Surgery, Hand and Upper Extremity Service, Hospital for Special Surgery, New York, New York
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15
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Park IJ, Maniglio M, Shin SS, Lim D, McGarry MH, Lee TQ. Internal Bracing Augmentation for Scapholunate Interosseous Ligament Repair: A Cadaveric Biomechanical Study. J Hand Surg Am 2020; 45:985.e1-985.e9. [PMID: 32434732 DOI: 10.1016/j.jhsa.2020.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/14/2020] [Accepted: 03/23/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Internal bracing (IB) is an augmentation method using high-strength nonabsorbable tape. This study compared scapholunate interosseous ligament (SLIL) repair alone, SLIL repair with IB augmentation (RIBA), and native intact SLIL (NIS) in a biomechanical cadaveric model. METHODS We used 21 specimens of fresh-frozen wrists in this study (7 matched pairs, SLIL repair-only and SLIL RIBA groups; and 7 independent fresh-frozen wrists, NIS group). In the SLIL RIBA group, augmentation using IB was performed after the repair. The specimens were preloaded and cyclically loaded in tension. Maximum extension and hysteresis were measured in all specimens. The specimens were subsequently tested for load to failure. Failure load (yield point load, mean ultimate load, and load at clinical failure) and linear stiffness were calculated. RESULTS In cyclic tensile testing, RIBA showed lower maximum extension and lower hysteresis than repair alone. In load to failure testing, the yield point load was statistically higher in the RIBA (59.3 N) group than in the repair-only (30.4 N) group but showed no significant difference compared with the NIS (90.7 N) groups. Moreover, the RIBA (98.5 N) group showed higher and lower mean ultimate loads than the repair-only (37.7 N) and NIS (211.8 N) groups, respectively. Load at clinical failure was higher with RIBA than with repair alone (3-mm extension: 70.0 vs 26.4 N; 4-mm extension: 84.1 vs 33.4 N). Repair alone and RIBA had comparable linear stiffness (38.2 vs 44.1 N/mm). CONCLUSIONS Although SLIL RIBA did not recreate biomechanical properties equivalent to those of NIS, it demonstrated a significantly higher strength than repair alone. CLINICAL RELEVANCE Repair with IB augmentation could serve as a novel surgical technique that enhances SLIL direct repair through biomechanical support.
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Affiliation(s)
- Il-Jung Park
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA; Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Mauro Maniglio
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA; Department of Orthopaedics and Traumatology, Inselspital Bern, University Hospital, Bern, Switzerland
| | - Steven S Shin
- Department of Orthopaedics, Cedars-Sinai Health System, Los Angeles, CA
| | - Dohyung Lim
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA; Department of Mechanical Engineering, Sejong University, Seoul, South Korea
| | - Michelle H McGarry
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA
| | - Thay Q Lee
- Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA
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16
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Daly LT, Daly MC, Mohamadi A, Chen N. Chronic Scapholunate Interosseous Ligament Disruption: A Systematic Review and Meta-Analysis of Surgical Treatments. Hand (N Y) 2020; 15:27-34. [PMID: 30027766 PMCID: PMC6966285 DOI: 10.1177/1558944718787289] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Although many techniques have been described, there is no clear optimal surgical treatment for chronic scapholunate interosseous ligament (SLIL) disruption. Methods: We identified 255 articles reporting outcomes of SLIL reconstruction. Of these, 40 studies (978 wrists) met eligibility requirements and reported sufficient data on radiographic outcomes to be included in the study. The mean and standard deviation of preoperative and follow-up assessments including scapholunate gap (SLG) and scapholunate angle (SLA) were used to calculate pooled standardized mean differences (SMD) with 95% confidence intervals (CIs). For other radiographic or clinical outcomes, there were not enough reported data to calculate a pooled effect size, and pooled nonstandardized comparisons were made. Results: The SMD between preoperative and postoperative SLA in tenodesis reconstruction was 0.7 (CI, 0.29 to 1.11, P = .001) and 0.04 (CI, -0.27 to 0.38, P = .8) for capsulodesis reconstruction. For SLG, tenodesis demonstrated an SMD of 1.1 (CI, 0.6 to 1.55, P < .001) compared with 0.1 (CI, -0.36 to 0.59, P = .6) for capsulodesis reconstruction. Tenodesis had a significant improvement compared with capsulodesis in SLA (P = .01) and SLG (P = .005). Tenodesis also showed improvement in grip strength and Disabilities of the Arm, Shoulder and Hand scores. Conclusions: Comparing preoperative and postoperative radiographic measurements, tenodesis reconstruction demonstrated significantly improved SLG and SLA relative to capsulodesis. Interpreted in the context of the limitations, existing data demonstrates some benefit of tenodesis reconstruction.
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Affiliation(s)
- Lauren T. Daly
- University of Massachusetts, Worcester,
USA,Lauren T. Daly, Division of Plastic Surgery,
University of Massachusetts, 55 Lake Avenue North, Worcester, MA 01605, USA.
| | - Michael C. Daly
- Harvard Medical School, Boston, MA,
USA,Massachusetts General Hospital, Boston,
USA
| | | | - Neal Chen
- Harvard Medical School, Boston, MA,
USA,Massachusetts General Hospital, Boston,
USA
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17
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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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18
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Kim JK, Lee SJ, Kang SH, Park JS, Park J, Kim GL. Long-term results of arthroscopic debridement and percutaneous pinning for chronic dynamic scapholunate instability. J Hand Surg Eur Vol 2019; 44:475-478. [PMID: 30661447 DOI: 10.1177/1753193418822680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There are various treatments for chronic dynamic scapholunate instability and there is still much debate about the best method of treatment. We retrospectively analysed 42 patients who had been treated by arthroscopic debridement and percutaneous pinning for chronic dynamic scapholunate instability. All patients were clinically improved without radiographic changes after surgery and were still satisfied at a mean follow-up of 68 months. Arthroscopic debridement and percutaneous pinning may be a good option for treating chronic dynamic scapholunate instability. Level of evidence: IV.
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Affiliation(s)
- Jin-Kak Kim
- 1 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Jin Lee
- 2 Department of Orthopaedic Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Sae-Hyun Kang
- 2 Department of Orthopaedic Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jun-Sik Park
- 2 Department of Orthopaedic Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jin Park
- 2 Department of Orthopaedic Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Gab-Lae Kim
- 2 Department of Orthopaedic Surgery, Hallym University College of Medicine, Seoul, Korea
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19
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Padmore CE, Stoesser H, Langohr GDG, Johnson JA, Suh N. Carpal Kinematics following Sequential Scapholunate Ligament Sectioning. J Wrist Surg 2019; 8:124-131. [PMID: 30941252 PMCID: PMC6443536 DOI: 10.1055/s-0038-1676865] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 11/12/2018] [Indexed: 12/21/2022]
Abstract
Background The scapholunate ligament (SLL) is the most commonly injured intercarpal ligament of the wrist. It is the primary stabilizer of the scapholunate (SL) joint, but the scaphotrapeziotrapezoid (STT) and radioscaphocapitate (RSC) ligaments may also contribute to SL stability. The contributions of SL joint stabilizers have been reported previously; however, this study aims to examine their contributions to SL stability using a different methodology than previous studies. Purpose The purpose of this in vitro biomechanical study was to quantify changes in SL kinematics during wrist flexion and extension following a previously untested sequential sectioning series of the SL ligament and secondary stabilizers. Methods Eight cadaveric upper extremities underwent active wrist flexion and extension in a custom motion wrist simulator. SL kinematics were captured with respect to the distal radius. A five-stage sequential sectioning protocol was performed, with data analyzed from 45-degree wrist flexion to 45-degree wrist extension. Results Wrist flexion and extension caused the lunate to adopt a more extended posture following sectioning of the SLL and secondary stabilizers compared with the intact state ( p < 0.009). The isolated disruption to the dorsal portion of the SLL did not result in significant change in lunate kinematics compared with the intact state ( p > 0.05). Scaphoid kinematics were altered in wrist flexion following sequential sectioning ( p = 0.013). Additionally, disruption of the primary and secondary stabilizers caused significant change to SL motion in both wrist flexion and wrist extension ( p < 0.03). Conclusions The SLL is the primary stabilizer of the SL articulation, with the STT and RSC ligaments playing secondary stabilization roles. Clinical Relevance Understanding the role primary and secondary SL joint stabilizers may assist in the development of more effective treatment strategies and patient outcomes following SLL injuries.
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Affiliation(s)
- Clare E. Padmore
- Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- The University of Western Ontario, London, Ontario, Canada
| | - Helen Stoesser
- Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- The University of Western Ontario, London, Ontario, Canada
| | - G. Daniel G. Langohr
- Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- The University of Western Ontario, London, Ontario, Canada
| | - James A. Johnson
- Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- The University of Western Ontario, London, Ontario, Canada
| | - Nina Suh
- Bioengineering Research Laboratory, Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care London, London, Ontario, Canada
- The University of Western Ontario, London, Ontario, Canada
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20
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Crawford K, Owusu-Sarpong N, Day C, Iorio M. Scapholunate Ligament Reconstruction: A Critical Analysis Review. JBJS Rev 2018; 4:e41-8. [PMID: 27487428 DOI: 10.2106/jbjs.rvw.o.00060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Scapholunate reconstruction procedures are best stratified according to preoperative stages of dissociative instability, injury chronicity, and arthrosis. In general, procedures aimed at correcting scapholunate instability focus on reestablishing ligament continuity in order to normalize carpal biomechanics; however, many existing interventions have shown differential success when performed on patients with varying stages of instability and degrees of carpal malalignment. The Mayo dorsal intercarpal ligament capsulodesis has proven most effective for preserving range of motion, whereas the Blatt capsulodesis has been associated with substantial improvements in terms of the postoperative pain rating and perceived functional capacity.
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Affiliation(s)
- Kayva Crawford
- Division of Plastic Surgery, Department of Surgery, and Division of Hand Surgery, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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21
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Yi R, Werner FW, Sikerwar S, Harley BJ. Force Required to Maintain Reduction of a Preexisting Scapholunate Dissociation. J Hand Surg Am 2018; 43:812-818. [PMID: 30049432 DOI: 10.1016/j.jhsa.2018.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 05/14/2018] [Accepted: 06/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the force required to maintain reduction of Geissler grade 4 scapholunate dissociations during physiological wrist motions. METHODS Fresh-frozen cadaveric wrists with Geissler grade 4 scapholunate dissociations were identified by arthroscopy. Following reduction, a load cell was attached to measure the force across the scapholunate joint at a neutral position and during 4 different wrist motions re-created using a servohydraulic wrist simulator, including a large flexion-extension motion (FEM), small and large dart-thrower's motions (DTMs), and a large DTM with ulnar offset. RESULTS Five wrists with isolated preexisting scapholunate interosseous ligament (SLIL) tears were analyzed. The force required to maintain reduction was significantly greater in extension than in flexion during the large FEM and large DTM with ulnar offset. The forces were significantly larger in this study of preexisting SLIL dissociations compared with results from a prior study of acutely sectioned SLILs. In addition, forces to maintain reduction during DTMs were significantly less than forces during FEMs. Finally, a set of 3 wrists with preexisting scapholunate and lunotriquetral interosseous ligament (LTIL) tears were identified and had significantly decreased forces to maintain reduction at maximum extension and had decreased maximal forces during a cycle of motion compared with the wrists with isolated SLIL tears. CONCLUSIONS The forces required to maintain reduction of a Geissler grade 4 wrist are higher than forces after acutely sectioned SLIL. The forces are greater in extension than in flexion and less during the DTM compared with the FEM. Wrists with both SLIL and LTIL tears required less force to maintain reduction than those with isolated SLIL tears. CLINICAL RELEVANCE This study helps determine the strength of reconstruction required to maintain reduction of a Geissler grade 4 scapholunate dissociation.
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Affiliation(s)
- Rosemary Yi
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY.
| | - Frederick W Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Sandeep Sikerwar
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Brian J Harley
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
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22
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Koehler SM, Beck CM, Nasser P, Gluck M, Hausman MR. The effect of screw trajectory for the reduction and association of the scaphoid and lunate (RASL) procedure: a biomechanical analysis. J Hand Surg Eur Vol 2018; 43:635-641. [PMID: 28886667 DOI: 10.1177/1753193417729257] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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 determine if screw placement in the reduction and association of the scaphoid and the lunate (RASL) procedure affected the ability of the scapholunate joint to withstand force. After completely disrupting of the scapholunate ligament in 29 fresh-frozen cadaveric wrists, we placed the RASL screw either distal or proximal to the lateral aspect of the dorsal ridge of the scaphoid and into the dorsal or volar aspect of the lunate. Specimens were subjected to repeated cycles of transcarpal axial force, mimicking clenched-fist loading, until failure. Screw placement distal to the lateral aspect of the dorsal scaphoid ridge was significantly associated with failure when examined manually, radiographically (1.8 vs. 0.5 mm) and using real-time motion capture (diastasis: 1.6 vs. 0.4 mm; Euler angle: 4.5 ° vs. 0.8 °). The lateral aspect of the dorsal ridge is a reliable radiographic landmark on the scaphoid and provides surgeons with a convenient starting point to achieve the most biomechanically stable RASL construct, and, therefore, enhances the potential for an optimal clinical outcome.
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Affiliation(s)
- Steven M Koehler
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Christina M Beck
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Philip Nasser
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Matthew Gluck
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
| | - Michael R Hausman
- Department of Orthopaedic Surgery, Mount Sinai Hospital, Mount Sinai Health System, New York, New York, USA
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23
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Jorge JT, Ferrão A, Alves S, Caetano R, Teixeira F. Arthroscopic Reduction-Association of the Scapholunate with an Absorbable Screw. J Wrist Surg 2018; 7:199-204. [PMID: 29922495 PMCID: PMC6005772 DOI: 10.1055/s-0037-1608878] [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: 11/28/2016] [Accepted: 10/20/2017] [Indexed: 10/18/2022]
Abstract
Background The treatment of chronic scapholunate instability is yet a controversial topic. Arthroscopic reduction-association scapholunate technique is a minimally invasive option in which a stable pseudoarthrosis at the scapholunate joint is obtained, allowing some degree of movement while maintaining the normal alignment of the wrist. The purpose of this study was to review the results of arthroscopic reduction-association scapholunate with an absorbable screw. Methods We retrospectively evaluated patients with dynamic or static, but reducible, chronic scapholunate instability who underwent arthroscopic reduction-association scapholunate between 2012 and 2015. An absorbable headless compression screw was used in the technique. Results A total of 33 patients (21 males, 12 females) were included. Average follow-up time was 17 months. At final follow-up, the average postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score was 18 (range, 8-46). The average postoperative grip strength was 30 kg, 73% of the uninjured side. The average extension-palmar flexion arc was 112 degrees, 79% of the uninjured side. The scapholunate angle decreased from 70 degrees preoperatively to 52 degrees postoperatively. In the cases of static lesion, the scapholunate interval decreased from 4.1 mm preoperatively to 2.8 mm at final follow-up. One patient had a breakage of the screw at 4 months, four developed a complex regional pain syndrome, one had a prominence of the screw at the waist of the scaphoid, and four maintained symptoms of instability. From these 10 patients, 5 were submitted to revision surgery. Conclusion The arthroscopic reduction-association technique is capable of maintaining the reduction of the scapholunate joint and of improving symptoms, while preserving range-of-motion. The use of an absorbable screw is an option in this technique, and may diminish screw-related complications.
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Affiliation(s)
| | - Ana Ferrão
- Department of Orthopedic Surgery, Hospital Curry Cabral, Lisboa, Portugal
| | - Sandra Alves
- Department of Orthopedic Surgery, Hospital Curry Cabral, Lisboa, Portugal
| | - Ruben Caetano
- Department of Orthopedic Surgery, Hospital Curry Cabral, Lisboa, Portugal
| | - Frederico Teixeira
- Department of Orthopedic Surgery, Hospital Curry Cabral, Lisboa, Portugal
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Abstract
Injuries to the hands and wrist are common in athletes. Injuries include acute fractures, dislocations, ligamentous, and tendon injuries, as well as more chronic injuries such as sprains and strains. Complications in the treatment of sports injuries of the hand and wrist may be divided into 2 categories: incorrect or delayed diagnosis and iatrogenic injury related to treatment. This article highlights common sports injuries of the hand and wrist and their complications, and includes tips for successful management.
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Affiliation(s)
- Nicholas Pulos
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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25
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Hiro ME, Schiffman CJ, Muriuki MG, Havey RM, Voronov LI, Bindra RR. Biomechanics of an Articulated Screw in Acute Scapholunate Ligament Disruption. J Wrist Surg 2018; 7:101-108. [PMID: 29576914 PMCID: PMC5864488 DOI: 10.1055/s-0037-1608637] [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: 05/26/2017] [Accepted: 09/30/2017] [Indexed: 10/18/2022]
Abstract
Background An injury to the scapholunate interosseous ligament (SLIL) leads to instability in the scapholunate joint. Temporary fixation is used to protect the ligament during reconstruction or healing of the repair. Rigid screw fixation-by blocking relative physiological motion between the scaphoid and lunate-can lead to screw loosening, pullout, and fracture. Purpose This study aims to evaluate changes in scaphoid and lunate kinematics following SLIL injury and the effectiveness of an articulating screw at restoring preinjury motion. Materials and Methods The kinematics of the scaphoid and lunate were measured in 10 cadaver wrists through three motions driven by a motion simulator. The specimens were tested intact, immediately following SLIL injury, after subsequent cycling, and after fixation with a screw. Results Significant changes in scaphoid and lunate motion occurred following SLIL injury. Postinjury cycling increased motion changes in flexion-extension and radial-ulnar deviation. The motion was not significantly different from the intact scapholunate joint after placement of the articulating screw. Conclusion In agreement with other studies, sectioning of the SLIL led to significant kinematic changes of the scaphoid and lunate in all motions tested. Compared with intact scapholunate joint, no significant difference in kinematics was found after placement of the screw indicating a correction of some of the changes produced by SLIL transection. These findings suggest that the articulating screw may be effective for protecting a SLIL repair while allowing the physiological rotation to occur between the scaphoid and lunate. Clinical Relevance A less rigid construct, such as the articulating screw, may allow earlier wrist rehabilitation with less screw pullout or failure.
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Affiliation(s)
- Matthew E. Hiro
- Division of Plastic Surgery, Bay Pines VA Medical Center, Bay Pines, Florida
| | - Corey J. Schiffman
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Muturi G. Muriuki
- Musculoskeletal Biomechanics Research Lab, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Robert M. Havey
- Musculoskeletal Biomechanics Research Lab, Edward Hines Jr. VA Hospital, Hines, Illinois
| | - Leonard I. Voronov
- Musculoskeletal Biomechanics Research Lab, Edward Hines Jr. VA Hospital, Hines, Illinois
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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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Biomechanical Properties of First Dorsal Extensor Compartment Regarding Adequacy as a Bone-Ligament-Bone Graft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1397. [PMID: 28831343 PMCID: PMC5548566 DOI: 10.1097/gox.0000000000001397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
Bone-ligament-bone grafts for reconstruction of the scapholunate ligament are a valuable tool to prevent disease progression to carpal collapse. Locally available grafts do not require an additional donor site. The first extensor compartment was evaluated biomechanically regarding its possible use as an autograft. METHODS Twelve native fresh-frozen, human cadaver specimens were tested by applying axial tension in a Zwick Roell machine. Load to failure, transplant elongation, and bony avulsion were recorded. The load to failure was quantitated in newtons (N) and the displacement in length (millimeters). Parameters were set at distinct points as start of tension, 1 mm stretch and 1.5 mm dissociation, failure and complete tear, and were evaluated under magnified visual control. Although actual failure occurred at higher tension, functional failure was defined at a stretch of 1.5 mm. RESULTS Mean load at 1 mm elongation was 44.1 ± 28 N and at 1.5 mm elongation 57.5 ± 42 N. Failure occurred at 111 ± 83.1 N. No avulsion of the bony insertion was observed. Half the transplants failed in the central part of the ligament, while the rest failed near the insertion but not at the insertion itself. Analysis of tension strength displayed a wide range from 3.8 to 83.7 N/mm at a mean of 33.4 ± 28.4 N/mm. CONCLUSIONS The biomechanical tensile properties of the first dorsal extensor compartment are similar to those of the dorsal part of the scapholunate ligament. A transplant with a larger bone stock and a longer ligament may display an advantage, as insertion is possible in the dorsal, easily accessible part of the carpal bones rather than in the arête-like region adjacent to the insertion of the scapholunate ligament. In this study, 1.5 mm lengthening of the bone-ligament-bone transplant was defined as clinical failure, as such elongation will cause severe gapping and is considered as failure of the transplant.
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Tommasini Carrara de Sambuy M, Burgess TM, Cambon-Binder A, Mathoulin CL. The Anatomy of the Dorsal Capsulo-Scapholunate Septum: A Cadaveric Study. J Wrist Surg 2017; 6:244-247. [PMID: 28725508 PMCID: PMC5515616 DOI: 10.1055/s-0036-1597922] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 12/03/2016] [Indexed: 10/20/2022]
Abstract
Background Tears of the dorsal radiocarpal capsule at the level of the scapholunate interosseous ligament (SLIL) have recently been described in association with predynamic scapholunate instability. Purpose The aim of this anatomical study of the dorsal capsulo-scapholunate septum (DCSS) was to examine the connection of the dorsal capsule on the SLIL and dorsal intercarpal ligament (DICL). Methods Fourteen fresh frozen wrists from seven adult cadavers were dissected through a dorsal approach. Any dorsal attachment of the DICL on the dorsal surface of the SLIL, that is, the DCSS, was identified and measured (height and width). Results The DCSS was consistently found connecting the DICL, the dorsal radiocarpal capsule, and the dorsal aspect of the SLIL. It was formed by the confluence of three arches like intersecting ribs in gothic architecture. The mean dimensions of the DCSS were 5.8 mm in height and 4.0 mm in maximum width. Conclusion The DCSS that connects the SLIL with the dorsal capsule and DICL could be a constant structure of dorsal wrist. Further investigation is required to study the histology of the DCSS and its biomechanical properties in isolation to know whether the DCSS can be considered a secondary stabilizer of the scapholunate ligament complex. Clinical Relevance A better anatomical knowledge of scapholunate ligament complex could help understand and manage instability of the wrist.
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Affiliation(s)
| | | | - Adeline Cambon-Binder
- Department of Orthopaedic, Traumatology and Hand Surgery, Saint-Antoine Hospital, Paris, France
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Abstract
Recent laboratory research has disclosed that carpal ligaments exhibit different kinetic behaviors depending on the direction and point of application of the forces being applied to the wrist. The so-called helical antipronation ligaments are mostly active when the wrist is axially loaded, whereas the helical antisupination ligaments constrain supination torques to the distal row. This novel way of interpreting the function of the carpal ligaments may help in developing better strategies to treat carpal instabilities.
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Affiliation(s)
- Marc Garcia-Elias
- Hand & Upper Limb Surgery, Institut Kaplan, Passeig de la Bonanova, 9, 2on 2a, Barcelona 08022, Spain; Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Carrer de Villarroel 170, Barcelona 08036, Spain.
| | - Inma Puig de la Bellacasa
- Department of Anatomy, Facultat de Medicina, Universitat de Barcelona, Carrer de Villarroel 170, Barcelona 08036, Spain; Hand and Upper Extremity Surgery, Mútua de Terrassa Hospital Universitari, Plaça del Doctor Robert, 5, Terrassa 08221, Spain
| | - Corinne Schouten
- Department of Plastic and Reconstructive, Hand, and Aesthetic Surgery, Catharina Hospital Eindhoven, Vondelstraat 75H, Nijmegen 6512BD, The Netherlands
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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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Adolfsson L, Povlsen B. Arthroscopic Findings in Wrists with Severe Post-Traumatic Pain despite Normal Standard Radiographs. ACTA ACUST UNITED AC 2017; 29:208-13. [PMID: 15142688 DOI: 10.1016/j.jhsb.2003.12.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2002] [Accepted: 12/18/2003] [Indexed: 11/16/2022]
Abstract
This study assessed the role of diagnostic arthroscopy following a wrist injury in patients with normal standard radiographs, an unclear clinical diagnosis and persistent severe pain at 4 to 12 weeks. Forty-three patients were included after conservative management had failed to improve their wrist pain so that a stability test could be performed satisfactorily and underwent arthroscopy within 12 weeks. Arthroscopy revealed recent pathology in 41 wrists, of which 17 had significant ligament lesions that might have benefited from acute repair. We conclude that patients with marked persistent post-traumatic symptoms despite conservative management are likely to have sustained ligament injuries despite normal radiographs. We therefore recommend that under these circumstances an arthroscopy is carried out within 4 weeks if the patient and surgeon wish to acutely repair significant ligament injuries.
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Affiliation(s)
- L Adolfsson
- Department of Orthopaedic Surgery and Hand and Plastic Surgery, University Hospital, Linköping, Sweden
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Marcuzzi A, Leti Acciaro A, Caserta G, Landi A. Ligamentous Reconstruction of Scapholunate Dislocation through a Double Dorsal and Palmar Approach. ACTA ACUST UNITED AC 2016; 31:445-9. [PMID: 16678315 DOI: 10.1016/j.jhsb.2006.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2004] [Accepted: 02/20/2006] [Indexed: 10/24/2022]
Abstract
Six patients, were treated for scapholunate dissociation by reconstruction of both the palmar and dorsal parts of the scapholunate interosseous ligament through a combined palmar and dorsal approach. The mean active range of motion of the wrist at final follow-up was 44° of flexion and 58° of extension and the mean hand grip strengths was 88% of that of the contralateral hand. The average time to return to work was 105 days and the mean DASH score at a mean follow-up of 32 months was 18. At follow-up, radiographs showed maintenance of the anatomical reduction of the scapholunate articulation in all cases and the scapholunate angle was normal in five patients.
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Affiliation(s)
- A Marcuzzi
- Unit of Hand Surgery and Microsurgery, Policlinico of Modena, Italy.
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Abstract
Wrist and hand injuries are common among athletes, and can lead to considerable disability. Dislocations and soft tissue injuries are common and require prompt recognition and treatment. Accurate diagnosis and early immobilization are often key to getting players back to their sport early. Some injuries require surgery; operative intervention allows the player to return to their sport more quickly or with less long-term disability. This article discusses the spectrum of injury from distal radius fractures to mallet fingers, and offers some general guidelines for the surgeon in how to counsel and treat athletes with these problems.
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Affiliation(s)
- Andrea Halim
- Division of Hand Surgery, Department of Orthopaedics, Alpert Medical School of Brown University, 2 Dudley Street, Suite 200, Providence, RI 02905, USA
| | - Arnold-Peter C Weiss
- Division of Hand Surgery, Department of Orthopaedics, Alpert Medical School of Brown University, 2 Dudley Street, Suite 200, Providence, RI 02905, USA.
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35
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Abstract
Background Treating chronic scapholunate ligament injuries without the presence of arthritis remains an unsolved clinical problem facing wrist surgeons. This article highlights a technique for reconstructing the scapholunate ligament using novel fixation, the ScaphoLunate Axis Method (SLAM). Materials and Methods In a preliminary review of the early experience of this technique, 13 patients were evaluated following scapholunate ligament reconstruction utilizing the SLAM technique. Description of Techinque The scapholunate interval is reconstructed utilizing a palmaris longus autograft passed between the scaphoid and lunate along the axis of rotation in the sagittal plane. It is secured in the lunate using a graft anchor and in the scaphoid utilizing an interference screw. The remaining graft is passed dorsally to reconstruct the dorsal scapholunate ligament. Results At an average follow-up of 11 months, the mean postoperative scapholunate gap was 2.1 mm. The mean postoperative scapholunate angle was 59 degrees. The mean postoperative wrist flexion and extension was 45 and 56 degrees, respectively. The mean grip strength was 24.9 kg, or 62% of the contralateral side. The mean pain score (VAS) was 1.7. There was 1 failure with recurrence of the pathologic scapholunate gap and the onset of pain. Conclusion While chronic scapholunate ligament instability remains an unsolved problem facing wrist surgeons, newer techniques are directed toward restoring the normal relationships of the scaphoid and lunate in both the coronal and sagittal planes. The SLAM technique has demonstrated promise in preliminary clinical studies.
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Affiliation(s)
- Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
| | - Dan A. Zlotolow
- Department of Orthopaedic Surgery, Philadelphia Shriners Hospital, Temple School of Medicine, Philadelphia, Pennsylvania
| | - Steve K. Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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36
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Waters MS, Werner FW, Haddad SF, McGrattan ML, Short WH. Biomechanical Evaluation of Scaphoid and Lunate Kinematics Following Selective Sectioning of Portions of the Scapholunate Interosseous Ligament. J Hand Surg Am 2016; 41:208-13. [PMID: 26718075 DOI: 10.1016/j.jhsa.2015.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the relative roles of the dorsal and volar portions of the scapholunate interosseous ligament (SLIL) in the stability of the scaphoid and lunate. METHODS Sixteen fresh cadaver wrists were moved through physiological motions using a wrist joint simulator. Electromagnetic sensors measured the motion of the scaphoid and lunate. Data were collected with the wrist intact, after randomly sectioning the dorsal SLIL first (8 wrists) or the volar SLIL first (8 wrists), and after full ligamentous sectioning. Differences in the percent increase in scaphoid flexion or lunate extension were compared using a t test with significance set at P < .05. RESULTS Sectioning the dorsal SLIL accounted for 37%, 72%, and 68% of the increase in scaphoid flexion in wrist flexion-extension, radioulnar deviation, and dart throw motion as compared with complete SLIL sectioning. Sectioning the volar SLIL accounted for only 7%, 6%, and 14%, respectively. In the same 3 motions, sectioning the dorsal SLIL accounted for 55%, 57%, and 58% of the increase in lunate extension, whereas volar SLIL sectioning accounted for 27%, 28%, and 22%. CONCLUSIONS The dorsal SLIL provides more stability to the scaphoid and lunate in biomechanical testing. The volar SLIL does provide some, although less, stability. CLINICAL RELEVANCE Although this study supports the critical importance of dorsal SLIL repairs or reconstructions, it also shows that there may be some value in implementing a volar SLIL repair or reconstruction.
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Affiliation(s)
- Michael S Waters
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Frederick W Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY.
| | - Stefanos F Haddad
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Michael L McGrattan
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
| | - Walter H Short
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
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Gandhi MJ, Knight TP, Ratcliffe PJ. Scapholunate ligament reconstruction using the palmaris longus tendon and suture anchor fixation in chronic scapholunate instability. Indian J Orthop 2016; 50:616-621. [PMID: 27904216 PMCID: PMC5122256 DOI: 10.4103/0019-5413.193484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multiple reconstruction techniques have been described in the management of chronic scapholunate (SL) instability, either based on the capsulodesis or tenodesis principle. It is uncertain which surgical method produces the best patient outcomes. We describe results of a technique using palmaris longus (PL) tendon for surgical reconstruction of the SL ligament and provide functional outcomes scores. MATERIALS AND METHODS We surgically reconstructed the SL ligament using a PL tendon graft secured with Mitek® bone anchors. Surgical technique with photographs is provided in the main text. Functional outcomes were measured using the disabilities of the arm, shoulder, and hand and Mayo wrist scores. Patient satisfaction was assessed using a simple measure. RESULTS Eleven patients attended mid-term followup (mean 45.8 months post-surgery) and had functional outcomes and satisfaction of this procedure that compared favorably to case series that used tenodesis for chronic SL ligament injuries. Almost all patients (n = 10) were able to return to regular employment. The majority of patients (n = 10) were satisfied with their primary reconstruction procedure. CONCLUSION This technique avoids the use of drill holes to weave tendon through bone, uses an easy to access graft, and exploits the superior pullout strength of anchors while offering satisfactory functional outcomes that are comparable to alternative tenodesis techniques.
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Affiliation(s)
- Maulik Jagdish Gandhi
- Department of Postgraduate, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Shropshire, SY10 7AG, UK,Address for correspondence: Dr. Maulik Jagdish Gandhi, Orthopaedic Institute, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, SY10 7AG, UK. E-mail:
| | - Timothy Paul Knight
- Department of Postgraduate, Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Trust, Shropshire, SY10 7AG, UK
| | - Peter John Ratcliffe
- Department of Trauma and Orthopaedics, Worcester Royal Hospital, Worcester, WR5 1DD, UK
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Elgammal A, Lukas B. Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients. J Hand Surg Eur Vol 2016; 41:56-63. [PMID: 26058802 DOI: 10.1177/1753193415587871] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 04/21/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The purpose of this retrospective study was to assess the modified Brunelli technique for the treatment of chronic irreparable complete scapholunate ligament rupture, causing a reducible carpal malalignment without secondary osteoarthritis. A total of 20 patients were treated using this technique. At a mean follow-up period of 24 months (range 6-53, SD 15), pain on a visual analogue scale had improved from 6 (range 3-10) to 3 (range 0-7). Function measured with the DASH score had improved from 37 (range 11-90) to 20 (range 0-53). Range of motion was reduced in flexion by a mean of 19° (range 10-45), and in extension by a mean of 14° (range 0-35). Mean grip strength at last follow-up was 81% of the uninjured hand (range 50-100%) Three patients developed scapholunate advanced collapse (stage II) requiring salvage surgery. Scapholunate ligament reconstruction with the modified Brunelli technique showed satisfactory results in this study. Extended studies are needed to determine the long-term benefits of this reconstructive procedure. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | - B Lukas
- Hand, Elbow and Plastic Surgery Department, Schön Klinik München, Harlaching, Germany
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39
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Abstract
BACKGROUND Prior to volar locked plating and early motion protocols, ligamentous injuries incidentally associated with distal radius fractures may have been indirectly treated with immobilization. Our goal was to determine the prevalence of scapholunate instability in our population, while identifying those who may have had progression of instability. METHODS We retrospectively reviewed 221 distal radius fractures treated with a volar locking plate during a 6-year period. Average patient age was 59 years. Standard posteroanterior and lateral radiographs from the first and last postoperative visits were analyzed for scapholunate instability, using the criteria of scapholunate gap ≥3 mm and scapholunate angle ≥60°. RESULTS Six patients (3 %) met neither or only one criterion for instability at the first postoperative visit and did not have ligament repair and then went on to meet both criteria at the last postoperative visit after an early motion protocol. Seven patients (3 %) met both criteria at the first and last postoperative visits and did not have ligament repair. Five patients (2 %) underwent primary scapholunate ligament repair at the time of distal radius fixation. CONCLUSIONS In our representative population, scapholunate instability was uncommon, either from initial injury or possible progression of occult ligament injury, despite early motion without operative treatment of the ligament. Thus, we did not find strong evidence for routinely delaying motion or pursuing further workup. When early radiographs clearly demonstrate acute scapholunate instability, more aggressive treatment may be appropriate for selected patients.
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Affiliation(s)
- Virginia M. Jones
- Boston University Orthopaedic Surgery Residency, 725 Albany Street 4B, Boston, MA 02118 USA
| | - Nathan G. Everding
- Boston University Orthopaedic Surgery Residency, 725 Albany Street 4B, Boston, MA 02118 USA
| | - Jason M. Desmarais
- Tufts University School of Medicine, 145 Harrison Avenue, Boston, MA 02111 USA
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van Kampen RJ, Bayne CO, Moran SL, Berger RA. Outcomes of Capitohamate Bone-Ligament-Bone Grafts for Scapholunate Injury. J Wrist Surg 2015; 4:230-238. [PMID: 26539325 PMCID: PMC4626222 DOI: 10.1055/s-0035-1556866] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose In an attempt to restore natural carpal kinematics more closely, bone-ligament-bone (BLB) grafts have been described for treating scapholunate (SL) injury. In this article we report the long-term results of capitohamate BLB autograft for the treatment of SL dissociation. Methods The medical records of patients treated with capitohamate BLB grafts for SL dissociation were retrospectively reviewed. Twenty-three patients were available for evaluation. Patients were sent a Disabilities of the Arm, Shoulder, and Hand (DASH) and a Patient-Rated Wrist Evaluation (PRWE) questionnaire and returned for exam. Thirteen patients returned the questionnaire, and 12 wrists were examined. Range of motion, grip strength, pain, complications, return to work, and radiographic parameters were documented. Results The average length of follow-up evaluation was 9.2 years. The average SL gap was 4.5 mm preoperatively and 3.6 mm at final follow-up. The average SL angle was 70 degrees preoperatively and 73 degrees at final follow-up. There was no statistically significant difference in preoperative versus postoperative flexion, extension, radial deviation, ulnar deviation, or grip strength. The average postoperative visual analog scale (VAS) score was 1.25 at rest and 3.58 with activity. The average Mayo Wrist Score was 66.8 preoperatively and 70.9 postoperatively (p = 0.158). The average postoperative PRWE was 20.5, and average postoperative DASH was 15.1. At final follow-up, four patients had no radiographic evidence of arthritis. Two patients had evidence of early-stage radiocarpal arthritis, four had evidence of midcarpal arthritis, and two had radiographic evidence of mild scaphotrapeziotrapezoid arthritis. One patient required a salvage procedure with four-corner fusion. Discussion BLB reconstruction can be used to treat SL instability. At final follow-up, the majority of patients did not worsen clinically or functionally or require secondary salvage procedures; however, radiologic progression of arthritis was not prevented. These outcomes are comparable to midterm results of other SL reconstructive options; thus, we have abandoned this technique for other less technically demanding procedures. Level of Evidence IV.
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Affiliation(s)
| | | | - Steven L. Moran
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Richard A. Berger
- Division of Hand Surgery, Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota
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41
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Abstract
Left untreated, scapholunate dissociation can lead to posttraumatic wrist arthritis. Multiple surgical procedures have been designed to reduce the scapholunate interval, restore normal wrist kinematics, and prevent the development of arthritis. Unfortunately, current surgical procedures have not been shown to consistently maintain radiographic alignment at long-term follow-up and result in decreased wrist range of motion and strength compared with the contralateral side. The purpose of this article is to review the current reconstructive options for scapholunate ligament tears without evidence of radiographic arthritis.
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Affiliation(s)
- Patrick J Ward
- Department of Orthopaedic Surgery, University of Pittsburgh, Suite 1010, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - John R Fowler
- Department of Orthopaedic Surgery, University of Pittsburgh, Suite 1010, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA.
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Abstract
Acute treatment of scapholunate instability is important to prevent future complications of dorsal intercalated segment instability and scapholunate advanced collapse. An understanding of the fundamental normal and abnormal mechanics of this problem is vital. Diagnosis in the acute phase is based on clinical and radiographic findings and treatment focuses on primary scapholunate interosseous ligament repair with a reinforcing dorsal capsulodesis. Suture anchor repair with a modified "double-dorsal" capsulodesis is described. Current data show that open repair is a viable option in the acute setting with most patients demonstrating good to excellent functional, clinical, and radiographic results.
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Affiliation(s)
- Morgan M Swanstrom
- Hospital for Special Surgery, Hand and Upper Extremity Service, 523 East 72nd Street, New York, NY 10021, USA
| | - Steve K Lee
- Hospital for Special Surgery, Hand and Upper Extremity Service, 523 East 72nd Street, New York, NY 10021, USA.
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Kang L, Ek ET, Wei MT, Meyers KN, Hearns KA, Carlson MG. Biomechanical Analysis of Scapholunate Ligament Repair Techniques. J Hand Surg Am 2015; 40:1534-9. [PMID: 25986650 DOI: 10.1016/j.jhsa.2015.03.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 03/26/2015] [Accepted: 03/26/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical properties of 3 scapholunate repair techniques. METHODS In 51 cadavers, the scapholunate ligament was exposed through a dorsal approach, incised at its scaphoid insertion, and repaired using 1 of 3 techniques: 2 single-loaded suture anchors, 2 double-loaded suture anchors, or 2 transosseous sutures. Twenty-four repaired specimens underwent load to failure (LTF) testing using tensile distraction on a servo-hydraulic machine. Twenty-seven specimens underwent cyclical testing to measure gap formation at the scapholunate joint. RESULTS The mode of failure was suture pullout through the substance of the ligament in 22 specimens, failure at the bone suture interface in 1, and anchor pullout in 1. Double-loaded anchor repairs demonstrated a significantly higher mean ultimate LTF compared with single-loaded anchor (91 N vs 35 N) and transosseous (91 N vs 60 N) repairs. Transosseous repairs demonstrated a higher mean ultimate LTF compared with single-loaded suture repairs (60 N vs 35 N). After 300 cycles, the average gap for the transosseous repair group was double that for the single- and double-loaded repairs, although not statistically significant. CONCLUSIONS Primary scapholunate ligament repairs using double-loaded suture anchors demonstrated significantly higher strength compared with single-loaded anchors and transosseous repairs. On cyclic loading, transosseous repairs demonstrated the greatest gap formation with no measurable difference between single- and double-loaded repairs. CLINICAL RELEVANCE In a cadaveric model for primary repairs, double-loaded suture anchors demonstrated the highest LTF and offer a similar but unproven performance in vivo.
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Affiliation(s)
- Lana Kang
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Eugene T Ek
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Mike T Wei
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Kathleen N Meyers
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Krystle A Hearns
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery and the Department of Biomechanics, Hospital for Special Surgery, New York, NY.
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Fok MWM, Fernandez DL. Chronic scapholunate instability treated with temporary screw fixation. J Hand Surg Am 2015; 40:752-8. [PMID: 25648782 DOI: 10.1016/j.jhsa.2014.12.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 11/22/2014] [Accepted: 12/02/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the efficacy of scapholunate (SL) temporary screw fixation to maintain the reduction of SL interval after ligament debridement, repair, or reconstruction. METHODS A total of 36 patients who had chronic SL instability were included. Arthroscopic debridement was performed for dynamic instability, and primary repair or reconstruction of the SL ligament was performed for static instability. We then used SL screw fixation for the protection of the repair or reconstruction. Screws were removed when loosening was noted on x-ray. RESULTS The average patient age was 43 years. Eleven had dynamic instability, and 25 had static instability. The average follow-up was 7.9 years. Nearly 95% of the patients had no more than mild pain. The average ranges of movement of the wrist were 55° extension, 51° flexion, 26° ulnar deviation, and 15° radial deviation. Postoperative x-ray revealed an average SL angle of 56°. The average SL gap was 2.5 mm. Both of these radiographic parameters were maintained at final follow-up. Dorsal intercalated segmental instability (DISI) deformity was not corrected in 2 patients. One patient had avascular changes in the proximal scaphoid and lunate but remained asymptomatic at 7 years postoperatively. There was no further intercarpal and radiocarpal degeneration. CONCLUSIONS Temporary SL screw fixation together with arthroscopic debridement, ligament repair, or reconstruction provided a stable closure of the SL interval and satisfactory clinical and functional results along with a low incidence of complication. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Diego L Fernandez
- Department of Orthopaedic Surgery, Lindenhof Hospital, Bern, Switzerland
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Abstract
OBJECTIVE The article reviews a select group of traumatic upper extremity injuries that can be easily misinterpreted on radiographs. CONCLUSION The awareness of these specific injuries and an understanding of their underlying pathophysiology and the role that radiographs can play in their evaluation will give the reader the best opportunity to make the important imaging findings and guide appropriate treatment.
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Wrist essentials: the diagnosis and management of scapholunate ligament injuries. Plast Reconstr Surg 2014; 134:312e-322e. [PMID: 25068352 DOI: 10.1097/prs.0000000000000423] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the pathophysiology of a scapholunate injury. 2. Understand how to diagnose scapholunate injuries 3. Formulate and carry out a surgical plan for patients with a scapholunate injury. SUMMARY Scapholunate ligament instability is the most common form of carpal instability. Untreated scapholunate injuries can lead to a predictable pattern of wrist arthritis. Early forms of scapholunate ligament instability can be missed, and clinical detection relies on an educated observer. This article covers the basic anatomy and biomechanics of the wrist, and reviews in detail scapholunate ligament injury. This article also reviews and discusses the current relevant topics and issues surrounding scapholunate ligament injury.
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Rohman EM, Agel J, Putnam MD, Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am 2014; 39:2020-6. [PMID: 25156088 DOI: 10.1016/j.jhsa.2014.06.139] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/27/2014] [Accepted: 06/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare outcomes of treatment for scapholunate instability between acute (< 6 wk from injury) and chronic (> 6 wk) injuries, between complete and partial tears, and among surgical techniques; identify risk factors for surgical failure; and compare ligament reconstruction with repair with or without capsulodesis in the chronic period. METHODS We performed a retrospective chart review of 82 primary scapholunate interosseous ligament surgeries, with median follow-up of 150 days. A total of 27 patients underwent surgery in the acute period and 50 in the chronic period. (In 5 patients we were unable to determine acuity or chronicity of injury.) In the chronic period, 16 patients underwent repair with or without capsulodesis, 27 underwent ligament reconstruction, and 7 underwent other procedures. RESULTS Surgical intervention in the acute setting involved more complex injuries, most commonly used direct repair, and produced a significantly lower failure rate than chronic intervention. In the chronic setting, the most common technique was ligament reconstruction, which produced superior radiographic outcomes compared with repair with or without capsulodesis. Isolated scapholunate interosseous ligament injuries undergoing chronic surgical intervention composed the majority of failures. Workers' compensation status and chronic intervention were significant risk factors for failure. CONCLUSIONS For chronic injuries, ligament reconstruction produced better radiographic outcomes than repair with or without capsulodesis. Acute intervention (within 6 wk) was preferable to chronic intervention for scapholunate interosseous ligament injuries, and a substantial number of isolated injuries failed to receive treatment in the acute period. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
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Affiliation(s)
- Eric M Rohman
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Julie Agel
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Matthew D Putnam
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN
| | - Julie E Adams
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN.
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Lee SK, Zlotolow DA, Sapienza A, Karia R, Yao J. Biomechanical comparison of 3 methods of scapholunate ligament reconstruction. J Hand Surg Am 2014; 39:643-50. [PMID: 24559758 DOI: 10.1016/j.jhsa.2013.12.033] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 12/30/2013] [Accepted: 12/30/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the biomechanical characteristics of 3 methods of scapholunate (SL) ligament reconstruction, including 1 that provides a biological central axis tether. METHODS Twelve fresh-frozen cadaver limbs were mounted on a jig that allowed for wrist and finger motion by tendon loading. The specimens were randomized to receive the SL axis method (SLAM) reconstruction, the Blatt capsulodesis (BC), or the modified Brunelli tenodesis (MBT). Fluoroscopic images were taken to measure the SL interval and SL angle in various positions. The specimens were evaluated in 4 states: intact, with the SL and radioscaphocapitate ligaments cut, after reconstruction, and after reconstruction followed by 100 cycles of simulated motion. RESULTS After cycling, the MBT and the SLAM reconstructions performed significantly better than the BC in recreating the intact SL interval in a clenched fist posture. The SLAM SL interval trended to be closer to the intact state than the MBT SL interval. The SLAM reconstruction also trended toward greater restoration of the native SL angle in the clenched fist posture than either the MBT or the BC. CONCLUSIONS The SL ligament reconstruction that uses a 2-tailed tendon autograft placed along the axis of rotation of the SL joint and secured both at the scaphoid and the lunate minimized creep and reconstructed the critical dorsal SL ligament. The SLAM achieved improved the SL interval and SL angle correction compared with conventional techniques of SL ligament reconstruction. CLINICAL RELEVANCE The SLAM method may be a useful alternative for SL ligament reconstruction.
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Affiliation(s)
- Steve K Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Department of Orthopaedic Surgery, Philadelphia Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY.
| | - Dan A Zlotolow
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Department of Orthopaedic Surgery, Philadelphia Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Anthony Sapienza
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Department of Orthopaedic Surgery, Philadelphia Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Raj Karia
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Department of Orthopaedic Surgery, Philadelphia Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA; Department of Orthopaedic Surgery, Philadelphia Shriners Hospital for Children, Philadelphia, PA; Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY
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Foo TL, Lim BH. Early results of combined palmar-dorsal scapholunate ligament reconstruction. 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 2014; 19:33-8. [PMID: 24641738 DOI: 10.1142/s0218810414500063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Isolated dorsal scapholunate reconstruction may be inadequate to stabilize and restore physiological scapholunate kinematics in the setting of combined dorsal and palmar ligamental incompetence. To address this entity, a combined reconstruction that encompass both dorsal and palmar scapholunate reconstruction was performed in 20 patients followed up to 19.8 (6-84) months. Compared to the contralateral wrist, the results were extension (67 ± 1.6 to 85.7%, p < 0.01), flexion (84.5 ± 3.2 to 81 ± 2.3%, p = 0.38), grip strength (62 ± 1.6 to 88.3 ± 1.9%, p < 0.01), and pain score (rest: 1.55 ± 0.26 to 0.2 ± 0.09, p < 0.01; activity: 3.2 ± 0.09 to 0.4 ± 0.17, p < 0.01). Based on Mayo wrist score, five excellent, 13 good, and two fair results were reported.
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Affiliation(s)
- Tun-Lin Foo
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore 119228, Singapore
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Post-traumatic carpal instability. Orthop Traumatol Surg Res 2014; 100:S45-53. [PMID: 24461233 DOI: 10.1016/j.otsr.2013.06.015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/20/2013] [Accepted: 06/20/2013] [Indexed: 02/02/2023]
Abstract
The complexity of the carpus explains the difficulty treating carpal injuries. Lesions are dominated by perilunate dislocation, scapholunate dislocation, and scaphoid fractures. The other injuries are trivial. Symptoms include pain and loss of wrist strength, reversible for an acute and well-treated lesion. Too often, these ligament injuries are diagnosed late. For delays longer than 6 weeks, ligament repair is ineffective. These old, complex lesions are potentially highly arthritic in the radiocarpal and mediocarpal joints. Improvements in wrist surgery have mitigated these chronic lesions. Various surgical techniques can preserve a functional wrist; wrist arthrodesis is no longer the only solution for these arthritic wrists. Over the past decade, arthroscopy has contributed to better understanding the injuries of the carpus as well as to better healing them. For acute or chronic ligament injuries without degenerative osteoarthritis, arthroscopy is the treatment of the future. This technique involves a long learning curve and the various arthroscopic techniques must be validated.
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