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Merlini L, Mathoulin C. Arthroscopic Repair of the Dorsal Intercarpal Ligament Detachment from the Scaphoid. J Wrist Surg 2021; 10:539-542. [PMID: 34881111 PMCID: PMC8635838 DOI: 10.1055/s-0041-1728803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
Background The dorsal intercarpal ligament, whose role in dorsal stability of the wrist has been shown, can be harmed in case of injury to the dorsal scapholunate complex. However, dorsal intercarpal ligament injury also seems to exist isolated posttraumatic forms of dorsal intercarpal ligament rupture, much rarer, through bony avulsion on its scaphoid insertion. The authors report the first description of this lesion, and propose a technique for arthroscopic repair. Description of Technique Radiocarpal arthroscopy will confirm the bony avulsion of the dorsal intercarpal ligament from the scaphoid. Under arthroscopic control, an anchor can be placed into the dorsal aspect of the scaphoid and the ligament can be reattached along with the dorsal capsule. Patients and Methods Between 2018 and 2020, seven patients underwent arthroscopic repair of this particular injury. They presented a painful preoperative wrist with decreased range of motion, and were treated arthroscopically, with anchored reinsertion of the ligament on the scaphoid. Results After a mean follow-up period of 12 months, arthroscopic repair showed decreased pain (6.7 to 0.2), improved range of motion in flexion (66 to 82 degrees) and extension (57 to 87 degrees°), and improved Disabilities of the Arm, Shoulder, and Hand (DASH) score (68.45 to 2.23). Conclusions This lesion has so far never been reported in the literature, and seems mechanically different from more common injuries of the scapholunate complex and dorsal capsulo-scapholunate septum with which dorsal intercarpal ligament ruptures are frequently associated. Arthroscopic repair with an anchor is possible without difficulty and seems to give very good results at 1-year follow-up (normal strength and range of motion).
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Affiliation(s)
- Lorenzo Merlini
- Institut de la Main, International Wrist Center, Clinique Bizet, Paris, France
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Margulies IG, Xu H, Gopman JM, Freeman MD, Dayan E, Taub PJ, Melamed E. Narrative Review of Ligamentous Wrist Injuries. J Hand Microsurg 2021; 13:55-64. [PMID: 33867762 PMCID: PMC8041499 DOI: 10.1055/s-0041-1724224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ligamentous wrist injuries are common occurrences that require complex anatomical mastery and extensive understanding of diagnostic and treatment modalities. The purpose of this educational review article is to delve into the most clinically relevant wrist ligaments in an organized manner to provide the reader with an overview of relevant anatomy, function, clinical examination findings, imaging modalities, and options for management. Emphasis is placed on elucidating reported diagnostic accuracies and treatment outcomes to encourage evidence-based practice.
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Affiliation(s)
- Ilana G. Margulies
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, United States
| | - Hope Xu
- Section of Plastic Surgery, University of Chicago, Chicago, Illinois, United States
| | - Jared M. Gopman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Matthew D. Freeman
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Etan Dayan
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Peter J. Taub
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Eitan Melamed
- Division of Plastic and Reconstructive Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, United States
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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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de Roo MGA, Dobbe JGG, van der Horst CMAM, Streekstra GJ, Strackee SD. Carpal kinematic changes after scaphoid nonunion: an in vivo study with four-dimensional CT imaging. J Hand Surg Eur Vol 2019; 44:1056-1064. [PMID: 31409175 PMCID: PMC6838662 DOI: 10.1177/1753193419866598] [Citation(s) in RCA: 4] [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: 02/03/2023]
Abstract
The aim was to evaluate if motion between the scaphoid bone fragments is related to the position of the fracture line and if a scaphoid nonunion results in the uncoupling of the proximal and distal carpal row during wrist motion. The influence of dorsal intercalated segment instability on interfragmentary motion was also analysed. In this study, 12 patients were included with unilateral scaphoid nonunion. Four-dimensional computerized tomography was used to analyse flexion-extension and radioulnar deviation motion of both wrists. We found that an increased instability of the scaphoid fragments is associated with the presence of dorsal intercalated segment instability and is not dependent on the position of the fracture line relative to the scaphoid apex. Additionally, a scaphoid nonunion results in an uncoupling of the carpal rows.
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Affiliation(s)
- Marieke G. A. de Roo
- Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam UMC, AMC, Amsterdam, Netherlands,Biomedical Engineering and Physics, University of Amsterdam, Amsterdam UMC, AMC, Amsterdam, Netherlands,Marieke G. A. de Roo, Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam UMC, AMC, Amsterdam, Netherlands.
| | - Johannes G. G. Dobbe
- Biomedical Engineering and Physics, University of Amsterdam, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | | | - Geert J. Streekstra
- Biomedical Engineering and Physics, University of Amsterdam, Amsterdam UMC, AMC, Amsterdam, Netherlands
| | - Simon D. Strackee
- Plastic, Reconstructive and Hand Surgery, University of Amsterdam, Amsterdam UMC, AMC, Amsterdam, Netherlands
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Abstract
After reviewing this article, readers should have a comprehensive understanding of the indications for diagnostic arthroscopy, technical considerations in performing a systematic evaluation of the wrist, and limitations of this technique.
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Affiliation(s)
- Brett F. Michelotti
- Department of Surgery, Division of Plastic Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
| | - Kevin C. Chung
- Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School
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Matson AP, Dekker TJ, Lampley AJ, Richard MJ, Leversedge FJ, Ruch DS. Diagnosis and Arthroscopic Management of Dorsal Wrist Capsular Impingement. J Hand Surg Am 2017; 42:e167-e174. [PMID: 28259281 DOI: 10.1016/j.jhsa.2016.12.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/28/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Dorsal wrist capsular impingement (DWCI) is characterized by pain attributable to impingement of dorsal capsular tissue during wrist extension. The diagnostic criteria and management algorithm for this condition have not been well established. The aims of our study were (1) to retrospectively review the clinical presentation and arthroscopic findings of patients treated surgically for DWCI and (2) to evaluate the outcomes of arthroscopic debridement for this condition. METHODS A total of 19 patients were treated with arthroscopic debridement for isolated DWCI from 2006 to 2015 by two surgeons (M.J.R. and D.S.R.) at a single institution. A chart review was performed to gather information on clinical presentation, radiological findings, operative details, and outcomes including numeric pain scale rating, range of motion, Mayo wrist score, and Quick Disabilities of the Arm, Shoulder, and Hand score. Patients were contacted at the time of the study for final telephone follow-up. RESULTS Symptoms were present for a median of 12.5 months (range, 3.5-124.4 mo) prior to surgical intervention, and all patients had pain localized to the dorsal and central wrist with passive terminal wrist extension (100%; 19 of 19). We obtained magnetic resonance imaging in 66% of patients (12 of 19). Diagnostic arthroscopy yielded evidence of infolded, redundant dorsal capsular tissue in all cases (19 of 19), and there was no evidence of concomitant wrist pathology. Compared with preoperative values, postoperative improvements were seen in average numeric pain scale rating (6.0-1.9), Quick Disabilities of the Arm, Shoulder, and Hand score (45.8-4.8), and Mayo wrist score (50.0-87.8). These improvements were sustained at 41.6 months after surgery (range, 11.9-73.8 months). One complication of superficial cellulitis occurred. CONCLUSIONS Dorsal wrist capsular impingement is a clinical diagnosis; magnetic resonance imaging may be helpful in evaluating for other pathologies. Diagnostic arthroscopy yields evidence of redundant dorsal capsular tissue, and arthroscopic debridement of this tissue offers a safe and effective treatment to improve pain and functional scores. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Andrew P Matson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Travis J Dekker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Alexander J Lampley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Marc J Richard
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - Fraser J Leversedge
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC
| | - David S Ruch
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
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Van Overstraeten L, Camus EJ. The role of extrinsic ligaments in maintaining carpal stability – A prospective statistical analysis of 85 arthroscopic cases. HAND SURGERY & REHABILITATION 2016; 35:10-5. [DOI: 10.1016/j.hansur.2015.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 09/20/2015] [Accepted: 09/29/2015] [Indexed: 11/15/2022]
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Sulkers GSI, Schep NWL, Maas M, Strackee SD. Intraobserver and interobserver variability in diagnosing scapholunate dissociation by cineradiography. J Hand Surg Am 2014; 39:1050-4.e3. [PMID: 24815911 DOI: 10.1016/j.jhsa.2014.03.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the intraobserver and interobserver variability in diagnosing scapholunate dissociation (SLD) by wrist cineradiography. METHODS A musculoskeletal radiologist, hand surgeon, and trauma surgeon assessed the records of 50 consecutive wrist cineradiographies performed in 25 patients. Fluoroscopy was performed on the unaffected and affected wrist and consisted of radiographer-controlled passive flexion-extension and passive radial-ulnar deviation in both posteroanterior and lateral projections. To determine the intraobserver variability, the 3 reviewers reassessed all wrist cineradiographies 6 months after their first assessment. The kappa coefficient for interobserver agreement was calculated using the jackknife method. The Cohen kappa was used to assess intraobserver variability. RESULTS The interobserver variability for diagnosing SLD by cineradiography was excellent (κ = 0.84). The intraobserver variability for the hand surgeon was excellent (κ = 0.80), and was good for the radiologist (κ = 0.72) and the trauma surgeon (κ = 0.76). CONCLUSIONS Cineradiography is a promising and helpful, noninvasive tool for diagnosing SLD. It is widely available and has relatively low costs. Conventional radiographs remain essential in the primary workup for suspected SLD. However, we recommend cineradiography when an SLD is clinically suspected. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
- George S I Sulkers
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
| | - Niels W L Schep
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Mario Maas
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Simon D Strackee
- Department of Plastic, Reconstructive, and Hand Surgery; the Trauma Unit, Department of Surgery; and the Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
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Sulkers GSI, Schep NWL, Maas M, van der Horst CMAM, Goslings JC, Strackee SD. The diagnostic accuracy of wrist cineradiography in diagnosing scapholunate dissociation. J Hand Surg Eur Vol 2014; 39:263-71. [PMID: 23697681 DOI: 10.1177/1753193413489056] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Ruptures of the scapholunate ligament (SLL) may cause carpal instability, also known as scapholunate dissociation (SLD). SLD may lead to osteoarthritis of the radiocarpal and midcarpal joints. The aim of this retrospective study was to determine the diagnostic value of wrist cineradiography in detecting SLD. All cineradiographic studies made during a 24 year period were retrieved. All patients who underwent the confirmation method (arthroscopy and/or arthrotomy) and cineradiography were included. In total, 84 patients met the inclusion criteria. Sensitivity, specificity, likelihood ratio, positive predictive value, negative predictive value, and diagnostic accuracy for detecting SLD were calculated for radiography and cineradiography. Cineradiography had a sensitivity of 90%, a specificity of 97%, and a diagnostic accuracy of 0.93 in detecting SLD. Radiography had a sensitivity of 81%, a specificity of 80%, and a diagnostic accuracy of 0.81. Cineradiography has a high diagnostic value for diagnosing SLDs. A positive cineradiography markedly increases the post-test probability of SLD.
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Affiliation(s)
- G S I Sulkers
- 1Department of Plastic, Reconstructive and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
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Current innovations in wrist arthroscopy. J Hand Surg Am 2012; 37:1932-41. [PMID: 22916867 DOI: 10.1016/j.jhsa.2012.06.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 02/02/2023]
Abstract
It has become clear that the stability of the scapholunate joint does not depend wholly on the scapholunate interosseous ligament, but rather on both primary and secondary stabilizers, which form a scapholunate ligament complex. Each case of scapholunate instability is unique and should be treated with tissue-specific repairs, which may partly explain why one procedure cannot successfully restore joint stability in every case. Wrist arthroscopy has a pivotal role in both the assessment and treatment of the scapholunate ligament complex derangements. Tears of the foveal attachment of the triangular fibrocartilaginous complex can be an underdiagnosed cause of distal radioulnar joint instability, because the foveal fibers cannot be visualized using the standard radiocarpal arthroscopy portals. Distal radioulnar joint arthroscopy allows for direct visualization and assessment of these fibers, which in turn has spawned a number of open and arthroscopic repair methods. Wrist arthroscopy has gained wider acceptance as a method to fine-tune articular reduction during open and percutaneous fixation of distal radius fractures, and simplifies intra-articular osteotomies for malunion. It can facilitate percutaneous bone grafting of scaphoid nonunions and has a role in the diagnosis and treatment of associated soft tissue lesions. These and other recent developments will be discussed in the following article.
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Assessment of Volar Radiocarpal Ligaments: MR Arthrographic and Arthroscopic Correlation. AJR Am J Roentgenol 2012; 198:423-7. [DOI: 10.2214/ajr.11.6919] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Slutsky DJ, Nagle DJ. Wrist arthroscopy: current concepts. J Hand Surg Am 2008; 33:1228-44. [PMID: 18762125 DOI: 10.1016/j.jhsa.2008.07.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 07/22/2008] [Accepted: 07/22/2008] [Indexed: 02/02/2023]
Abstract
Wrist arthroscopy has steadily grown from a mostly diagnostic tool to a valuable adjunctive procedure in the treatment of myriad wrist disorders. The number of conditions that are amenable to arthroscopic treatment continues to grow. A detailed knowledge of the topographical and intracarpal anatomy, however, is essential to minimize complications and maximize the benefits. Although wrist arthroscopy can identify an anatomic abnormality, it cannot be used to differentiate between an asymptomatic degenerative condition versus a pathologic lesion that is the cause of wrist pain. A thorough wrist examination is still integral to any arthroscopic assessment. This article focuses on the methodology behind a normal arthroscopic wrist examination and discusses some of the more standard arthroscopic procedures along with the expected outcomes.
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