Arthroscopic Scapholunate Synthetic Ligamentoplasty

BMP2 and GDF5 for Compartmentalized Regeneration of the Scapholunate Ligament

Background  Chronic injuries to the scapholunate ligament (SLIL) alter carpal kinematics and may progress to early degenerative osteoarthritis. To date, there is no consensus for the best method for SLIL reconstruction. This study aims to assess the use of growth factors (bone morphogenetic protein [BMP]2 and growth and differentiation factor 5 [GDF5]) for compartmentalized regeneration of bone and ligament in this multiphasic scaffold in a rabbit knee model. Case Description  A total of 100 µg of BMP2 and 30 µg of GDF5 were encapsulated into a heparinized gelatin-hyaluronic acid hydrogel and loaded into the appropriate compartment of the multiphasic scaffold. The multiphasic scaffold was implanted to replace the native rabbit medial collateral ligament ( n  = 16). The rabbits were randomly assigned to two different treatment groups. The first group was immobilized postoperatively with the knee pinned in flexion with K-wires for 4 weeks ( n  = 8) prior to sacrifice. The second group was immobilized for 4 weeks, had the K-wires removed followed by a further 4 weeks of mobilization prior to sample harvesting. Literature Review  Heterotopic ossification as early as 4 weeks was noted on gross dissection and confirmed by microcomputed tomography and histological staining. This analysis revealed formation of a bony bridge located within and over the ligament compartment in the intra-articular region. Biomechanical testing showed increased ultimate force of the ligament compartment at 4 weeks postimplantation consistent with the presence of bone formation and higher numbers of scaffold failures at the bone-tendon junction. This study has demonstrated that the addition of BMP2 and GDF5 in the bone-ligament-bone (BLB) scaffold resulted in heterotopic bone formation and failure of the ligament compartment. Clinical Relevance  The implantation of a three-dimensional-printed BLB scaffold alone demonstrated superior biomechanical and histological results, and further investigation is needed as a possible clinical reconstruction for the SLIL.

Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears

Background  Many debates are still ongoing for the management of chronic scapholunate (SL) injuries. We have proposed an arthroscopic technique of dorsal capsulodesis with good clinical results. We now propose a radiological follow-up. Purpose  To determine if arthroscopic dorsal capsulodesis can improve the radiographic SL angle and maintain this correction over time. Methods  From January 2020 to January 2021, we included every patient with an SL instability and sorted them according to the European Wrist Arthroscopy Society (EWAS) classification. All patients had bilateral X-rays with a measurement of the radiolunate (RL) and SL angles for both the pathologic and healthy side. We also included patients with lunotriquetral or triangular fibrocartilage complex lesions. The exclusion criteria were the presence of arthritis and persistent intraoperative SL instability after capsulodesis. An arthroscopic dorsal capsulodesis was performed in all patients as originally described by Mathoulin. The RL and SL angles were then again measured on the immediate postoperative X-ray, and then again at 3, 6, and 12 months postoperatively. The statistical analysis was done using a paired Student's t -test with 145 degrees of freedom and α = 0.05. Results  We included a total of 146 patients with a 1-year follow-up. Both the RL angle and the SL angles approach the healthy side at 12 months postoperatively. The RL angle has increased from -7.23 degrees to 4.37 degrees; the difference is still statistically significative, but it is almost equal to the healthy side (5.16 degrees). The SL angle has lowered from 74.55 to 54.95; the difference is still statistically and radiologically significative (6.788 degrees) but has been lowered by 74.3%. Conclusion  This study shows that this technique can normalize the dorsal intercalated segment instability (DISI) over time without the need for any pinning or invasive ligament reconstructive surgery. Level of Evidence  Level IV, cohort study. Clinical Relevance  Dorsal capsulodesis should be considered in all reducible SL injuries, even when DISI is present.

Clinical Outcomes of Arthroscopic-Assisted Volar Scapholunate Capsulodesis: A Case Series

Purpose  We have previously described arthroscopic-assisted volar scapholunate (SL) capsulodesis as an alternative technique for addressing volar SL interosseous ligament (SLIL) injuries. In this article, we report the outcomes of this procedure in a cohort of patients. Methods  Postoperative outcomes including range of motion, grip strength, visual analog scale (VAS) pain score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Mayo Wrist Score were assessed through a prospective review of six patients in a single center who underwent this procedure. Results  Six patients (four male and two female) with a mean age of 43 ± 14 years were evaluated in the study. The mean duration of follow-up was 41 ± 17 weeks. Postoperative outcomes noted a reduction in VAS pain score from 8 before surgery to 0.7 postoperatively ( p  = 0.00004) and improvement in Mayo Wrist Score (42 preoperatively to 80 postoperatively; p  = 0.001), grip strength (86% of contralateral side; p  = 0.20), and flexion arc (81% of contralateral side; p  = 0.08). QuickDASH was 20 ± 8 and Patient-Rated Wrist Evaluation score was 13 ± 2 at the last clinical follow-up. There was an improvement in SL gap ( p  = 0.03), SL angle ( p  = 0.11), and radiolunate angle ( p  = 0.15) measurements postoperatively. Conclusions  The described arthroscopic-assisted volar SL capsulodesis in this study presents an alternative method to address volar SLIL pathology with positive short-term clinical outcomes. Clinical Relevance  Arthroscopic-assisted volar SL capsulodesis may be considered in the treatment algorithm for volar SLIL injuries.

Arthroscopic-Assisted Volar Scapholunate Capsulodesis: A New Technique

Most current surgical techniques for scapholunate interosseous ligament injuries address the dorsal component only. Previously, volar capsulodesis has been described either as an open approach or an "all-inside" technique. In this article, we report an alternative arthroscopic technique to address volar scapholunate interosseous ligament injuries. Arthroscopic-assisted volar scapholunate capsulodesis may be considered in the treatment algorithm for volar scapholunate interosseous ligament injuries.