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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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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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Mathoulin C, Gras M. Role of wrist arthroscopy in scapholunate dissociation. Orthop Traumatol Surg Res 2020; 106:S89-S99. [PMID: 31740161 DOI: 10.1016/j.otsr.2019.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/14/2019] [Accepted: 07/18/2019] [Indexed: 02/02/2023]
Abstract
Scapholunate ligament tear is most frequently encountered in the aftermath of trauma in supination and extension of the wrist. It generates chronic instability, leading to osteoarthritis. It may be associated with fracture of the distal epiphysis of the radius or of the scaphoid. These lesions are often difficult to diagnose, especially in early stages. Treatment of chronic scapholunate ligament lesions before onset of osteoarthritis is a challenge for the surgeon. To date, recommendations are for open reconstruction or repair, which can improve pain and grip strength, but very often at the cost of wrist stiffness. The advent of arthroscopy has completely changed the understanding and treatment of these lesions. The present review focuses on recent contributions to the anatomy of the scapholunate complex and the anatomopathology of these dissociations, and explores classical treatments and the emerging role of arthroscopy. We shall seek to answer five questions: (1) What are the anatomical bases of the scapholunate complex, (2) What is the initial clinical and paraclinical work-up for scapholunate dissociations, and how are they to be classified, (3) What are the classical treatments for scapholunate dissociation, (4) What are the technical principles and results of arthroscopic treatment, (5) What are the limits and perspectives of arthroscopic treatment?
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Affiliation(s)
- Christophe Mathoulin
- Institut de la Main, Clinique Bizet, 22, bis Rue Georges-Bizet, 75116 Paris, France.
| | - Mathilde Gras
- Institut de la Main, Clinique Bizet, 22, bis Rue Georges-Bizet, 75116 Paris, France
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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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5
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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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Kamrani RS, PanjaviLee B, Vahedi E. Mid-Term Results of the Use of a Suture Anchor Fixation for Chronic Reducible Scapholunate Dissociation. J Hand Surg Asian Pac Vol 2019; 24:440-446. [PMID: 31690193 DOI: 10.1142/s2424835519500565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Scapholunate dissociation (SLD) is a common and sometimes disabling ligamentous injury of the wrist. The aim of the treatment is to restore carpal alignment and to prevent joint degeneration. In the current study, we reported mid-term results of our technique using suture anchor fixation within the SL interface. Methods: Nine male patients with an average age of 35 years underwent scapholunate suture anchor fixation (SLAF) for chronic and symptomatic dynamic or reducible static SLD from 2011 to 2016 with a mean follow-up of 36 months. After dorsal wrist exposure, a 2.8 mm suture anchor was inserted in the dorsoproximal lateral articular surface of the lunate bone. The two ends of the sutures were passed through the two divergent canals in the scaphoid. The sutures were tied over the tuberosity after reducing the SL alignment. Two K-wires supported SL and scaphocapitate (SC) alignment for 8 weeks. Radiographic parameters, wrist range of motion and grip strength were measured. Quick-DASH and Modified Mayo Wrist Score (MMWS) were used to assess the functional outcome. Results: The grip strength and passive motion reached to 75% and 88% of the other side, respectively. The SL gap was 5.4 mm, 2.6 mm and 3.4 mm before surgery, after pin removal, and on the follow-up stress radiographs, respectively. The SL angle was 82, 52 and 65 degrees at any time point, respectively. Average Quick-DASH score was improved from 60 to 25. According to MMWS score, one patient was excellent, one was good, five were fair, and two were poor. Conclusions: SLAF is a simple technique with minimal soft tissue manipulation that enables correction and maintaining of the carpal alignment with favorable mid-term results.
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Affiliation(s)
- Reza Shahryar Kamrani
- Department of Orthopedics, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam PanjaviLee
- Department of Orthopedics, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Vahedi
- Department of Orthopedics, Dr. Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.,Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Chronic Reducible Scapholunate Ligament Dissociation: A Simple Surgical Technique for a Complex Injury. Tech Hand Up Extrem Surg 2019; 24:55-61. [PMID: 31436757 DOI: 10.1097/bth.0000000000000261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Report the outcomes following chondrectomy of scapholunate (SL) joint, temporary stabilization of the SL joint using Kirshner wires and extensor carpi radialis longus (ECRL) transfer to dorsal scaphoid pole to restore normal SL gap and correct dorsal intercalated ligament instability deformity. MATERIALS AND METHODS Retrospective case series of 11 patients with a mean age of 45 years were treated by the senior author 7 months after SL injury. The SL joint cartilage was removed, the SL joint was stabilized temporarily with 2 Kirshner wires for 8 weeks and ECRL tenodesis to scaphoid dorsally. Visual analog scale, disability of the arm, shoulder, and hand score, wrist flexion and extension range of motion, grip strength, return to work, SL gap, and SL angle were evaluated preoperatively and in last follow-up visit after the procedure. Modified Mayo score and complications were evaluated in the last visit. RESULTS Average follow-up was 15.6 months. In the last follow-up, the average visual analog scale pain score improved significantly from 6.4 to 1.5. Average postoperative grip strength improved significantly compared with preoperative strength (41 to 56 Ib). Average disability of the arm, shoulder, and hand score improved significantly postoperatively (30 to 18 points). Average Mayo score was satisfactory in the last visit. Average SL gap reduced significantly from 4.1 to 2.8 mm and average SL angle decreased significantly from 82 to 62 degrees. Postoperative extension-flexion arc of motion significantly decreased compared with preoperative measurements. SL advanced collapse developed in 1 case after 15 months follow-up. All patients return to regular work at a mean of 16 weeks. CONCLUSIONS Chronic reducible SL dissociation can be treated affectively with SL chonderectomy, temporary SL stabilization, and ECRL tenodesis to scaphoid to restore radiologic anatomy without compromising strength or work status. LEVEL OF EVIDENCE Therapeutic type IV.
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Abstract
Scapholunate ligament (SLL) injuries are a common cause of wrist pain and instability. Treatment of SLL injuries requires intricate understanding of wrist anatomy and biomechanics. Mindful physical exam and appropriate diagnostic studies can orient the surgeon to the defined stage of injury. Review of the literature on each treatment by stage can prepare the upper extremity surgeon to provide the best evidence-based care. The optimal management of SLL injuries should result in a stable, painless wrist.
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Affiliation(s)
- Geoffrey Konopka
- Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA,
| | - Harvey Chim
- Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL, USA,
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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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Kani KK, Mulcahy H, Porrino J, Daluiski A, Chew FS. Update on operative treatment of scapholunate (SL) instability for radiologists: part 1-SL ligament repair, dorsal capsulodesis and SL ligament reconstruction. Skeletal Radiol 2017; 46:1615-1623. [PMID: 28578528 DOI: 10.1007/s00256-017-2676-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 02/02/2023]
Abstract
Scapholunate instability is the most common form of carpal instability. Imaging (especially radiography) plays an important role in the staging, management and post-operative follow-up of scapholunate (SL) instability. The goals of this article are to review the pre-operative staging of SL instability, the surgical options for repair and reconstruction of the SL ligament, along with the normal postoperative imaging findings as well as complications associated with these surgical options.
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Affiliation(s)
- Kimia Khalatbari Kani
- Virginia Radiology Associates, P.C., 8629 Sudley Road, Suite 102, Manassas, VA, 20110, USA.
| | - Hyojeong Mulcahy
- University of Washington Radiology, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
| | - Jack Porrino
- University of Washington Radiology, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
| | - Aaron Daluiski
- Hand and Upper Extremity Surgery, Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Felix S Chew
- University of Washington Radiology, 4245 Roosevelt Way NE Box 354755, Seattle, WA, 98105, USA
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11
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Morrell NT, Moyer A, Quinlan N, Shafritz AB. Scapholunate and perilunate injuries in the athlete. Curr Rev Musculoskelet Med 2017; 10:45-52. [PMID: 28101827 DOI: 10.1007/s12178-017-9383-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF THE REVIEW Scapholunate and perilunate injuries can be difficult to diagnose and treat in the athlete. In this review article, we present the mechanism of injury, evaluation, management, and outcomes of treatment for these injuries. RECENT FINDINGS Acute repair of dynamic scapholunate ligament injuries remains the gold standard, but judicious use of a wrist splint can be considered for the elite athlete who is in season. The treatment of static scapholunate ligament injury remains controversial. Newer SL reconstructive techniques that aim to restore scapholunate function without compromising wrist mobility as much as tenodesis procedures show promise in athlete patients. Acute injuries to the scapholunate ligament are best treated aggressively in order to prevent the sequelae of wrist arthritis associated with long-standing ligamentous injury. Acute repair is favored. Reconstructive surgical procedures to manage chronic scapholunate injury remain inferior to acute repair. The treatment of lunotriquetral ligament injuries is not well defined.
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Affiliation(s)
- Nathan T Morrell
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA
| | - Amanda Moyer
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA
| | - Noah Quinlan
- University of Vermont College of Medicine, The University of Vermont Medical Center, Burlington, VT, USA
| | - Adam B Shafritz
- Department of Orthopaedics & Rehabilitation, University of Vermont College of Medicine, 95 Carrigan Drive Stafford Hall, Burlington, VT, 05405, USA.
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A Three-Dimensional Micro–Computed Tomographic Study of the Intraosseous Lunate Vasculature. Plast Reconstr Surg 2016; 138:869e-878e. [DOI: 10.1097/prs.0000000000002696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Han KD, Kim JM, DeFazio MV, Bello RJ, Katz RD, Parks BG, Means KR. Changes in Wrist Motion After Simulated Scapholunate Arthrodesis: A Cadaveric Study. J Hand Surg Am 2016; 41:e285-93. [PMID: 27570228 DOI: 10.1016/j.jhsa.2016.07.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 04/19/2016] [Accepted: 07/04/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE A high incidence of nonunion and relatively poor outcomes with prior fixation techniques has precluded scapholunate (SL) arthrodesis as a standard treatment for SL instability. Our purpose was to determine the impact on range of motion (ROM) of simulated SL arthrodesis via headless screw fixation. METHODS We performed baseline wrist ROM for 10 cadaveric wrists using a standardized mounting-and-weights system. Extension, flexion, radial deviation, ulnar deviation, dart-thrower's extension, and dart-thrower's flexion were assessed. Two 3.0-mm headless compression screws were inserted across the SL joint to simulate SL arthrodesis. Goniometric measurements and fluoroscopic imaging were repeated to assess ROM differences after simulated SL arthrodesis. We assessed SL angle and gap during testing to ensure there was no significant motion between the scaphoid and lunate, thus confirming stable simulated fusion. Differences in ROM were compared between baseline and simulated SL arthrodesis using paired t tests. RESULTS Mean SL angle remained constant between pre- and post-arthrodesis imaging (47° ± 6° vs 46° ± 4°) and did not change during post-arthrodesis ROM testing, indicating a stable simulated fusion. Compared with baseline, SL arthrodesis had a statistically significant reduction in maximum flexion of 6° and 9° based on fluoroscopy and goniometry, respectively, in dart-thrower's extension of 5° and 9° based on fluoroscopy and goniometry, respectively, and in dart-thrower's flexion of 6° for both fluoroscopy and goniometry. No other ROMs after simulated SL arthrodesis were significantly different compared with baseline. CONCLUSIONS The effects of simulated SL arthrodesis on radiocarpal and midcarpal motion compare favorably with motion after SL soft tissue repair and other reconstructive techniques that have been previously reported. The statistically significant decreases in wrist flexion and dart-thrower's extension-flexion after simulated SL arthrodesis are of questionable clinical importance. CLINICAL RELEVANCE These results may support reconsidering SL arthrodesis as a viable treatment option for acute or chronic SL instability with regard to apparent minimal adverse effects on functional wrist ROM.
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Affiliation(s)
- Kevin D Han
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Jaehon M Kim
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Michael V DeFazio
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | | | - Ryan D Katz
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Brent G Parks
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kenneth R Means
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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14
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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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