1
|
Rush MN, Salas C, Mottishaw L, Fountain D, Mercer D. Additive Manufacturing: The Next Generation of Scapholunate Ligament Reconstruction. J Wrist Surg 2021; 10:492-501. [PMID: 34881104 PMCID: PMC8635827 DOI: 10.1055/s-0041-1729993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/06/2021] [Indexed: 10/21/2022]
Abstract
Background Ligament reconstruction, as a surgical method used to stabilize joints, requires significant strength and tissue anchoring to restore function. Historically, reconstructive materials have been fraught with problems from an inability to withstand normal physiological loads to difficulties in fabricating the complex organization structure of native tissue at the ligament-to-bone interface. In combination, these factors have prevented the successful realization of nonautograft reconstruction. Methods A review of recent improvements in additive manufacturing techniques and biomaterials highlight possible options for ligament replacement. Description of Technique In combination, three dimensional-printing and electrospinning have begun to provide for nonautograft options that can meet the physiological load and architectures of native tissues; however, a combination of manufacturing methods is needed to allow for bone-ligament enthesis. Hybrid biofabrication of bone-ligament tissue scaffolds, through the simultaneous deposition of disparate materials, offer significant advantages over fused manufacturing methods which lack efficient integration between bone and ligament materials. Results In this review, we discuss the important chemical and biological properties of ligament enthesis and describe recent advancements in additive manufacturing to meet mechanical and biological requirements for a successful bone-ligament-bone interface. Conclusions With continued advancement of additive manufacturing technologies and improved biomaterial properties, tissue engineered bone-ligament scaffolds may soon enter the clinical realm.
Collapse
Affiliation(s)
- Matthew N. Rush
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Christina Salas
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico
- Department of Mechanical Engineering, The University of New Mexico, Albuquerque, New Mexico
| | - Lorraine Mottishaw
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Center for Biomedical Engineering, The University of New Mexico, Albuquerque, New Mexico
| | - Damian Fountain
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
- Department of Biochemistry and Molecular Biology, The University of New Mexico, Albuquerque, New Mexico
| | - Deana Mercer
- Department of Orthopaedics and Rehabilitation, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| |
Collapse
|
2
|
Hess D, Archual A, Burnett Z, Prakash H, Dooley E, Russell S, Freilich A, Dacus AR. Motion and Strength Analysis of 2-Tine Staple and K-Wire Fixation in Scapholunate Ligament Stabilization in a Cadaver Model. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:67-73. [PMID: 35415539 PMCID: PMC8991646 DOI: 10.1016/j.jhsg.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/30/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose Previous studies have demonstrated the benefits of 2- and 4-tine staple fixation in scapholunate interosseous ligament (SLIL) reconstruction, including improved rotational control and avoidance of the articular surface. This study compared scaphoid and lunate kinematics after SLIL fixation with traditional Kirschner wire (K-wire) fixation or 2-tine staple fixation. Methods Eight fresh frozen cadaver arms with normal scapholunate (SL) intervals were included. Infrared motion capture was used to assess kinematics between the scaphoid and lunate as the wrists were moved through a simulated dart-throw motion. Kinematic data were recorded for each wrist in 4 states: SLIL intact, SLIL sectioned, K-wire fixation across SL interval and scaphocapitate joint, and 2-tine Nitinol staple fixation across SL interval. Strength of the SL staple fixation was evaluated using an axial load machine to assess load to failure of the staple construct. Results Range of motion of the scaphoid and lunate with SLIL intact and SLIL sectioned were similar. K-wire fixation across the SL interval significantly decreased the overall wrist range of motion as well as scaphoid and lunate motion in all planes except for scaphoid flexion. Conversely, scaphoid and lunate motion after staple fixation was similar to that in normal wrists, except for a significant decrease in scaphoid extension. Under axial load simulating a ground-level fall, 3 of 8 arms demonstrated no failure, and none of the failures was due to direct failure of the 2-tine staple. Conclusions This study demonstrates 2-tine staple fixation across the SL interval is effective in providing initial stability and maintaining physiologic motion of the scaphoid and lunate compared with K-wire fixation after SLIL injury. Clinical relevance This study demonstrates an alternate technique for the stabilization of the SL interval in repair of acute SLIL injuries using 2-tine staple fixation, which maintains near physiologic motion of the scaphoid and lunate after SLIL injury.
Collapse
|
3
|
van Leeuwen WF, Menendez ME, Gaspar MP, Jacoby SM, Osterman AL, Chen N. Unplanned Reoperation After Surgery for Scapholunate Interosseous Ligament Insufficiency: A Retrospective Review of 316 Patients. Hand (N Y) 2019; 14:691-697. [PMID: 29504476 PMCID: PMC6759963 DOI: 10.1177/1558944718760034] [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: 11/16/2022]
Abstract
Background: The purpose of this study was to identify factors associated with unplanned reoperation after surgery for scapholunate interosseous ligament (SLIL) insufficiency. Methods: Using Current Procedural Terminology (CPT) codes from 3 hand surgery centers across 2 metropolitan areas, we identified 316 patients undergoing surgery for SLIL insufficiency from 2000 to 2014. Medical records were manually reviewed to collect data on factors that might be associated with unplanned reoperation, including age, sex, tobacco use, occupation, acuity of treatment, and reconstruction method. Results: Thirty-eight patients (12%) had an unplanned reoperation; most of them (65%) were a secondary reconstruction or salvage procedure (eg, 6 proximal row carpectomies, 9 revision reconstruction, and 10 partial carpal arthrodeses), while 5 (13%) were for unplanned screw removal. The median time between the index and second surgery was 16 months (range, 2-97 months). The type of index procedure was not associated with reoperation. The only factor associated with reoperation was cigarette smoking, and this association persisted when looking specifically at reoperations for revision or salvage. Conclusions: Patients should be counseled that smoking is associated with reoperation after SLIL surgery. Smoking cessation or decreasing nicotine usage may be beneficial prior to surgery. With the numbers available, there was no association between surgical technique and reoperation.
Collapse
Affiliation(s)
| | | | - Michael P. Gaspar
- The Philadelphia Hand Center, PA,
USA,Thomas Jefferson University,
Philadelphia, PA, USA
| | - Sidney M. Jacoby
- The Philadelphia Hand Center, PA,
USA,Thomas Jefferson University,
Philadelphia, PA, USA
| | - A. Lee Osterman
- The Philadelphia Hand Center, PA,
USA,Thomas Jefferson University,
Philadelphia, PA, USA
| | - Neal Chen
- Harvard Medical School, Boston, MA,
USA,Neal Chen, Department of Orthopaedic
Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, 55
Fruit Street, Yawkey 2C, Boston, MA 02114, USA.
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Meister DW, Hearns KA, Carlson MG. Dorsal Scaphoid Subluxation on Sagittal Magnetic Resonance Imaging as a Marker for Scapholunate Ligament Tear. J Hand Surg Am 2017; 42:717-721. [PMID: 28709793 DOI: 10.1016/j.jhsa.2017.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 05/23/2017] [Accepted: 06/14/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the diagnostic utility of scaphoid dorsal subluxation on magnetic resonance imaging (MRI) as a predictor of scapholunate interosseous ligament (SLIL) tears and compare this with radiographic findings. METHODS Thirty-six MRIs were retrospectively reviewed: 18 with known operative findings of complete Geissler IV SLIL tears that were surgically repaired, and 18 MRIs performed for ulnar-sided wrist pain but no SLIL tear. Dorsal subluxation of the scaphoid was measured on the sagittal MRI cut, which demonstrated the maximum subluxation. Independent samples t tests were used to compare radiographic measurements of scapholunate (SL) gap, SL angle, and capitolunate/third metacarpal-lunate angles between the SLIL tear and the control groups and to compare radiographic measurements between wrists that had dorsal subluxation of the scaphoid and wrists that did not have dorsal subluxation. Interrater reliability of subluxation measurements on lateral radiographs and on MRI were calculated using kappa coefficients. RESULTS Thirteen of 18 wrists with complete SLIL tears had greater than 10% dorsal subluxation of the scaphoid relative to the scaphoid facet. Average subluxation in this group was 34%. Four of 18 wrists with known SLIL tears had no subluxation. No wrists without SLIL tears (control group) had dorsal subluxation. The SL angle, capitolunate/third metacarpal-lunate angle and SL gap were greater in wrists that had dorsal subluxation of the scaphoid on MRI. Interrater reliability of measurements of dorsal subluxation of the scaphoid was superior on MRI than on lateral x-ray. CONCLUSIONS An MRI demonstration of dorsal subluxation of the scaphoid, of as little as 10%, as a predictor of SLIL tear had a sensitivity of 72% and a specificity of 100%. The high positive predictive value indicates that the presence of dorsal subluxation accurately predicts SLIL tear. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic II.
Collapse
Affiliation(s)
- David W Meister
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY
| | - Krystle A Hearns
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY
| | - Michelle G Carlson
- Division of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY.
| |
Collapse
|
6
|
Cortese J, Soubeyrand M, Razakamanantsoa L, Bellin MF, Creze M. Hamate and pisiform coalition: a case report and introduction to the carpal C-sign on lateral radiograph. Skeletal Radiol 2017; 46:693-699. [PMID: 28229185 DOI: 10.1007/s00256-017-2593-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] [Received: 07/20/2016] [Revised: 01/05/2017] [Accepted: 02/07/2017] [Indexed: 02/02/2023]
Abstract
Hamate-pisiform coalition is an exceptional form of carpal coalition. Case reports are essential to gain a better understanding of this variant. We report a case of congenital bilateral hamate-pisiform coalition in a 20-year-old male discovered in the context of a right wrist trauma. Radiographs also revealed a bilateral scapholunate diastasis. Clinical examination and radiological findings suggested that the right wrist scapholunate diastasis was related to scapholunate instability. Left wrist scapholunate diastasis could be related to (1) a pathological feature or (2) a normal variant associated with hamate-pisiform coalition. Lateral radiographs showed a volar C-shaped osseous bridge corresponding to the coalition. We associated it with a new sign: the "carpal C-sign". Computed tomography with three-dimensional reconstruction provides helpful information about the type of coalition (osseous versus non-osseous) and excludes potential fracture. We discuss the specific embryologic features of the hamate-pisiform coalition, as well as its prevalence, radiographic classification, clinical significance, and treatment.
Collapse
Affiliation(s)
- Jonathan Cortese
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France.
| | - Marc Soubeyrand
- Orthopaedic Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| | - Leo Razakamanantsoa
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| | - Marie-France Bellin
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| | - Maud Creze
- Radiology Department, Hôpital Bicêtre, 78 rue du Général Leclerc, 94266, Le Kremlin-Bicetre, France
| |
Collapse
|
7
|
Feehan L, Fraser T. Early controlled mobilization using dart-throwing motion with a twist for the conservative management of an intra-articular distal radius fracture and scapholunate ligament injury: A case report. J Hand Ther 2017; 29:191-8. [PMID: 27264904 DOI: 10.1016/j.jht.2016.02.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Revised: 02/22/2016] [Accepted: 02/25/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED This case describes an early controlled mobilization (ECM) approach that uses dart-throwing motion (DTM) with a twist orthoses as an alternative to immobilization for conservative management of a minimally displaced and intra-articular distal radius styloid fracture with an associated scapholunate ligament injury in a 47-year-old female health care administrator (JP). Pain-free active DTM began at day 10 (5 times/d) with a dynamic DTM with a twist orthosis worn during the day from weeks 3 to 6. At 6 weeks, JP had pain-free functional mobility and strength with minimal limitation in household and occupational activities, returning to her normal sporting activities by 3 months. ECM led to rapid return of normal functioning in the short term with no apparent impact on intermediate outcomes at 8 months. This case allows hand therapists to consider a similar ECM approach for the management of similar injuries in their patients. LEVEL OF EVIDENCE Level 5 and case report.
Collapse
Affiliation(s)
- Lynne Feehan
- Clinical Research, Rehabilitation Program, Fraser Health Authority, Surrey, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Trevor Fraser
- HealthOne Physiotherapy & Hand Clinic, Surrey, British Columbia, Canada
| |
Collapse
|
8
|
Feehan L, Fraser T. Dart-throwing motion with a twist orthoses: Design, fabrication, and clinical tips. J Hand Ther 2017; 29:205-12. [PMID: 27264905 DOI: 10.1016/j.jht.2015.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/01/2015] [Accepted: 12/21/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Lynne Feehan
- Lead, Clinical Research, Rehabilitation Program, Fraser Health Authority, Surrey, British Columbia, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Trevor Fraser
- HealthOne Physiotherapy & Hand Clinic, Surrey, British Columbia, Canada
| |
Collapse
|