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Lameire DL, Khalik HA, Paul RA, von Schroeder HP, Chan AHW. Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options. J Wrist Surg 2024; 13:374-388. [PMID: 39027024 PMCID: PMC11254481 DOI: 10.1055/s-0043-1768133] [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: 12/12/2022] [Accepted: 03/06/2023] [Indexed: 07/20/2024]
Abstract
Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III-IV studies.
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Affiliation(s)
- Darius Luke Lameire
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Ryan Augustine Paul
- Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
| | - Herbert P. von Schroeder
- Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
| | - Andrea H. W. Chan
- Division of Orthopaedic Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
- Division of Plastic and Reconstructive Surgery, University of Toronto Hand Program, Toronto, Ontario, Canada
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Ferreira Branco D, Botti P, Bouvet C, Abs B, Buzzi M, Beaulieu JY, Poletti PA, Bouredoucen H, Boudabbous S. Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI. Eur Radiol 2024:10.1007/s00330-024-10831-3. [PMID: 38856779 DOI: 10.1007/s00330-024-10831-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 04/26/2024] [Accepted: 05/21/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. MATERIALS AND METHODS This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. RESULTS Two-hundred ninety-five patients (mean age 39.6 +/- 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15-75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52-2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = -0.2415; p < 0.05) and a weak positive correlation between Guérini's classification and dorsal SL pain (r = 0.2466; p < 0.05). CONCLUSION High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. CLINICAL RELEVANCE STATEMENT High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon's preoperative assessment. KEY POINTS Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.
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Affiliation(s)
- David Ferreira Branco
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland.
| | - Paul Botti
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Cindy Bouvet
- Orthopedic and Traumatology Surgery Department, Hand Surgery Unit, Sion Hospital, Av. du Grand-Champsec 80, 1951, Sion, Switzerland
| | - Bilal Abs
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Marcello Buzzi
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Jean Yves Beaulieu
- Orthopedic and Traumatology Surgery Department, Hand Surgery Unit, Sion Hospital, Av. du Grand-Champsec 80, 1951, Sion, Switzerland
| | - Pierre-Alexandre Poletti
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Hicham Bouredoucen
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
| | - Sana Boudabbous
- Diagnostic Department, Radiology Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205, Genève, Switzerland
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Zhou JY, Jodah R, Joseph LP, Yao J. Scapholunate Ligament Injuries. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:245-267. [PMID: 38817761 PMCID: PMC11133945 DOI: 10.1016/j.jhsg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/13/2024] [Indexed: 06/01/2024] Open
Abstract
Injuries to the scapholunate interosseous ligament (SLIL) complex can result in a predictable cascade of incongruous motion in the carpus that leads to radiocarpal degeneration. Both acute traumatic impact and repetitive motion can render the SLIL insufficient. A thorough understanding of SLIL anatomy is required for appropriate diagnosis and treatment. Here, we review scapholunate ligament anatomy, prevention strategies, methods of diagnosis, nonoperative and operative treatments, and outcomes. A myriad of treatment options exist for each stage of the SLIL injury, and management should be an open discussion between the patient and physician.
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Affiliation(s)
- Joanne Y. Zhou
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | | | - Lauren P. Joseph
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA
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Lui H, Vaquette C, Denbeigh JM, Bindra R, van Wijnen AJ, Kakar S. BMP2 and GDF5 for Compartmentalized Regeneration of the Scapholunate Ligament. J Wrist Surg 2023; 12:418-427. [PMID: 37841358 PMCID: PMC10569873 DOI: 10.1055/s-0043-1761608] [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: 08/29/2022] [Accepted: 12/27/2022] [Indexed: 10/17/2023]
Abstract
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.
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Affiliation(s)
- Hayman Lui
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Cedryck Vaquette
- Centre for Oral Regeneration, Reconstruction and Rehabilitation (COR3), School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Randy Bindra
- School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
- Department of Orthopaedic Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Andre J. van Wijnen
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry, University of Vermont, Burlington, Vermont
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Haerle M, Schmelzer-Schmied N, Lampert FM. Arthroscopic Capsulodesis for the Treatment of Dynamic Scapholunate Dissociations. Tech Hand Up Extrem Surg 2023; 27:95-99. [PMID: 36382512 DOI: 10.1097/bth.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Management of scapholunate dissociations remains a significant challenge. Open approaches suffer from a disadvantageous further impairment of the stabilizing local structures. The minimally invasive arthroscopic technique described provides reliable stability of the scapholunate interosseous ligament complex in dynamic lesions. The anatomic key structure is the dorsal capsuloligamentous scapholunate septum, which provides a mechanical connection between the scaphoid, lunate, and dorsal capsule of the wrist. Arthroscopic capsuloplasty aims to tighten and stabilize this complex structure in long term. This approach preserves the adjacent structures, namely the secondary wrist stabilizers and their neuromuscular feedback loops. With a certain degree of experience in wrist arthroscopy, the technique is reliably adaptable and reproducible.
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Affiliation(s)
- Max Haerle
- Clinic for Hand and Plastic Surgery, Orthopedic Clinic Markgroeningen, Markgröningen
| | | | - Florian M Lampert
- Clinic for Hand and Plastic Surgery, Orthopedic Clinic Markgroeningen, Markgröningen
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Freiburg, Germany
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Trentadue TP, Lopez C, Breighner RE, Fautsch K, Leng S, Holmes III DR, Moran SL, Thoreson AR, Kakar S, Zhao KD. Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases. J Wrist Surg 2023; 12:248-260. [PMID: 37223378 PMCID: PMC10202581 DOI: 10.1055/s-0042-1758159] [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: 11/30/2021] [Accepted: 09/15/2022] [Indexed: 02/11/2023]
Abstract
Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.
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Affiliation(s)
- Taylor P. Trentadue
- Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Cesar Lopez
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Ryan E. Breighner
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
| | - Kalli Fautsch
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Shuai Leng
- Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota
| | - David R. Holmes III
- Biomedical Imaging Resource Division, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Steven L. Moran
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew R. Thoreson
- Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Sanjeev Kakar
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin D. Zhao
- Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
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Debril H, Saab M, Demondion X, Muys P, Cotten A, Jacques T. Anatomical study of the dorsal capsulo-scapholunate septum using high frequency ultrasonography. Orthop Traumatol Surg Res 2022; 109:103483. [PMID: 36435373 DOI: 10.1016/j.otsr.2022.103483] [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: 08/20/2020] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The dorsal capsulo-scapholunate septum (DCSS) is a recently described capsuloligamentous structure between the dorsal bundle of the scapholunate ligament (SLL) and the joint capsule of the wrist. It acts a secondary stabilizer of the scapholunate joint. The aim of this study was to evaluate the visibility and normal appearance of DCSS on high frequency ultrasound. HYPOTHESIS The DCSS can be analyzed using high frequency ultrasound. MATERIALS AND METHODS Three cadaveric wrists were dissected in order to study the DCSS; one without labeling and the other two after labeling under ultrasound guidance. On two other wrists, a correlation between the structure considered to be the DCSS on ultrasound and the corresponding CT arthrography and anatomical sections was carried out. Finally, sagittal ultrasound sections of the DCSS region on 42 healthy wrists were analyzed retrospectively. RESULTS During dissection, the DCSS corresponded to a fibrous structure extending to the dorsal surface of the scaphoid and lunate, with certain fibers converging towards the SLL. On high-frequency ultrasound, a hyperechoic fibrillar structure was visualized at the theoretical position of the DCSS. The dissections performed after ultrasound-guided transfixion showed that its limits corresponded to the limits of the DCSS. The anatomical, CT arthrography and ultrasound sections in the DCSS region were concordant. The DCSS was retrospectively visible on at least one reference ultrasound slice in 90.5% of healthy wrists, and was always hyperechoic. Its average thickness was 1.38±0.24mm. DISCUSSION Our study describes the normal sonographic characteristics of the DCSS, visible in a majority of healthy patients on high-frequency ultrasound. The analysis of the sonographic characteristics of the DCSS in the context of acute wrist trauma should be evaluated, and a diagnostic decision tree has been proposed. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Héloïse Debril
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France
| | - Marc Saab
- Service d'orthopédie 1, CHU de Lille, hôpital Roger-Salengro, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France
| | - Xavier Demondion
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Laboratoire d'anatomie, faculté de médecine de Lille, Lille, France; Faculté de médecine, université de Lille, Lille, France; Unité de taphonomie médico-légale & d'anatomie, ULR 7367, UTML&A, CHU de Lille, University Lille, 59000 Lille, France
| | - Paul Muys
- Laboratoire d'anatomie, faculté de médecine de Lille, Lille, France; Faculté de médecine, université de Lille, Lille, France
| | - Anne Cotten
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France; MABLab-Marrow Adiposity and Bone Lab ULR4490, université de Lille, université du Littoral Côte d'Opale, Lille, France.
| | - Thibaut Jacques
- Service de radiologie et d'imagerie musculo-squelettique, centre de consultation et d'imagerie de l'appareil locomoteur, CHU de Lille, avenue du Professeur Emile-Laine, 59000 Lille, France; Faculté de médecine, université de Lille, Lille, France
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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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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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Sapa MC, Igeta Y, Gouzou S, Facca S, Pizza C, Hidalgo Díaz JJ, Liverneaux P. Arthroscopic scapholunate dorsal capsulodesis: A 30-patient case series comparing postoperative splint immobilization versus immobilization and connected K-wiring. HAND SURGERY & REHABILITATION 2018; 37:352-357. [PMID: 30220618 DOI: 10.1016/j.hansur.2018.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/25/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Abstract
The aim of this retrospective study was to compare the results of arthroscopic dorsal capsulodesis performed with or without temporary K-wiring to treat patients who had sustained scapholunate ligament injuries. Our case series included 30 patients with an average age of 37 years (range: 19-55) of whom 12 were female. Dorsal scapholunate capsulodesis was carried out in all patients. In 15 patients, splint immobilization only was used (group I). For the remaining 15 patients, supplementary scapholunate and scaphocapitate K-wiring was performed (group II). The outcomes, whether K-wiring was used or not, were not as good as the outcomes of other published studies. In our study, the reported QuickDASH score was on average higher than 20/100, pain score was higher than 2/10, grip strength was less than 70% of the contralateral side. There was one postoperative complication in the first group and three complications in the second group; five cases of DISI were reported in the first group and three in the second group. There were no significant differences between the two groups. Based on our findings, supplementary K-wiring is not necessary when a dorsal scapholunate capsulodesis is performed. The outcomes of our study were not as good as those of other published series, potentially due to a shorter follow-up and the more severe ligament injuries in our case series.
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Affiliation(s)
- M-C Sapa
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - Y Igeta
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France; Department of Orthopedic Surgery, Juntendo University, 2-1-1 Hongo, 1138431 Tokyo, Bunkyo-ku, Japan
| | - S Gouzou
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - S Facca
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - C Pizza
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - J J Hidalgo Díaz
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France
| | - P Liverneaux
- Icube CNRS 7357, service de chirurgie de la main, université de Strasbourg, hôpitaux universitaires de Strasbourg, FMTS, 10, avenue Baumann, 67403 Illkirch cedex, France.
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Degeorge B, Coulomb R, Kouyoumdjian P, Mares O. Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year. J Wrist Surg 2018; 7:324-330. [PMID: 30174990 PMCID: PMC6117177 DOI: 10.1055/s-0038-1660446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Accepted: 04/23/2018] [Indexed: 12/21/2022]
Abstract
Purpose We retrospectively evaluated the results of all arthroscopic dorsal scapholunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro-computed tomography scan after failed medical treatment. Materials and Methods Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal intercalated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification. Results The mean follow-up period was 20.2 months (range, 12-41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB ( n = 8) or EWAS IIIC ( n = 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion-extension increased from 92.9 degrees preoperatively to 126.2 degrees postoperatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion-extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted. Discussion Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure. Level of Evidence This is a level IV, case series.
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Affiliation(s)
- Benjamin Degeorge
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
| | - Rémy Coulomb
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
| | - Pascal Kouyoumdjian
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
| | - Olivier Mares
- Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
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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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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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Arthroscopic Scapholunate Capsuloligamentous Repair: Suture With Dorsal Capsular Reinforcement for Scapholunate Ligament Lesion. Arthrosc Tech 2017; 6:e113-e120. [PMID: 28373948 PMCID: PMC5368283 DOI: 10.1016/j.eats.2016.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 09/09/2016] [Indexed: 02/03/2023] Open
Abstract
Scapholunate ligament (SLL) injury is the most frequent injury of the intrinsic carpal ligaments. The dorsal part of the SLL is the most important part for the stability of the scapholunate joint, and tears of this part and at least one of its secondary capsular attachments cause scapholunate dissociation. The arthroscopic technique most frequently used for acute injuries is reduction and fixation with Kirschner wires, and techniques that involve a primary repair of the injured ligament are performed by open surgery with efficient results. However, they lead to significant stiffness of the wrist due to injury to the soft tissue caused by damage to the secondary dorsal stabilizers; the dorsal blood supply; and in many cases, the proprioceptive innervation of the posterior interosseous nerve. We present an all-arthroscopic technique for the direct repair of acute injuries of the dorsal part of the SLL using bone anchors, complemented by a dorsal arthroscopic plication that reconstructs the dorsal capsulo-scapholunate septum of the scapholunate complex.
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Mathoulin C. Treatment of dynamic scapholunate instability dissociation: Contribution of arthroscopy. HAND SURGERY & REHABILITATION 2016; 35:377-392. [DOI: 10.1016/j.hansur.2016.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 08/23/2016] [Accepted: 09/14/2016] [Indexed: 02/02/2023]
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Lindau TR. The role of arthroscopy in carpal instability. J Hand Surg Eur Vol 2016; 41:35-47. [PMID: 26581604 DOI: 10.1177/1753193415616276] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/15/2015] [Indexed: 02/03/2023]
Abstract
Carpal instability is predominantly caused by trauma and presents as a painful wrist with signs and symptoms of weakness, clicking, clunking and a sense of giving way. Wrist arthroscopy is widely regarded as the 'gold standard' in diagnosing and understanding carpal instability. This article is based on an extensive literature search to evaluate the evidence behind the use of wrist arthroscopy in the assessment and management of these patients. There is convincing evidence supporting the role of arthroscopy in diagnosis and assessment of factors involved in the development of carpal instability, but weak evidence for the effectiveness of arthroscopic techniques in the actual treatment of this condition. The article reviews mechanisms behind, and the role for arthroscopy in the management of scapholunate, lunotriquetral, midcarpal and radiocarpal instability. It also presents how the author incorporates the 'evidence-base' into an 'experience-based' clinical practice.
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Shahabpour M, Staelens B, Van Overstraeten L, De Maeseneer M, Boulet C, De Mey J, Scheerlinck T. Advanced imaging of the scapholunate ligamentous complex. Skeletal Radiol 2015. [PMID: 26219592 DOI: 10.1007/s00256-015-2182-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The scapholunate joint is one of the most involved in wrist injuries. Its stability depends on primary and secondary stabilisers forming together the scapholunate complex. This ligamentous complex is often evaluated by wrist arthroscopy. To avoid surgery as diagnostic procedure, optimization of MR imaging parameters as use of three-dimensional (3D) sequences with very thin slices and high spatial resolution, is needed to detect lesions of the intrinsic and extrinsic ligaments of the scapholunate complex. The paper reviews the literature on imaging of radial-sided carpal ligaments with advanced computed tomographic arthrography (CTA) and magnetic resonance arthrography (MRA) to evaluate the scapholunate complex. Anatomy and pathology of the ligamentous complex are described and illustrated with CTA, MRA and corresponding arthroscopy. Sprains, mid-substance tears, avulsions and fibrous infiltrations of carpal ligaments could be identified on CTA and MRA images using 3D fat-saturated PD and 3D DESS (dual echo with steady-state precession) sequences with 0.5-mm-thick slices. Imaging signs of scapholunate complex pathology include: discontinuity, nonvisualization, changes in signal intensity, contrast extravasation (MRA), contour irregularity and waviness and periligamentous infiltration by edema, granulation tissue or fibrosis. Based on this preliminary experience, we believe that 3 T MRA using 3D sequences with 0.5-mm-thick slices and multiplanar reconstructions is capable to evaluate the scapholunate complex and could help to reduce the number of diagnostic arthroscopies.
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Affiliation(s)
- Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Barbara Staelens
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
| | | | - Michel De Maeseneer
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Cedric Boulet
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel (UZ Brussel), Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Thierry Scheerlinck
- Department of Orthopaedics and Traumatology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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