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Arnaout A, Mathoulin C. Arthroscopic management of scapholunate complex injuries associated with distal radius fractures. J Orthop 2024; 51:73-80. [PMID: 38333048 PMCID: PMC10847947 DOI: 10.1016/j.jor.2024.01.009] [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: 08/05/2023] [Accepted: 01/18/2024] [Indexed: 02/10/2024] Open
Abstract
Scapholunate complex injuries are the most frequent lesions associated with distal radius fractures and the treatment algorithm according to the stage of the instability remains controversial. However, there is an admitted consensus around the necessary treatment of the associated high-grade instabilities. They occur frequently in young patients after high energy trauma, and not treated, they can lead to chronic wrist pain and eventually to scapholunate advanced collapse. The routine use of the arthroscopy provides an accurate intraoperative staging of the lesions and allows a tailored treatment depending on the severity of the scapholunate instability.
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Affiliation(s)
- Ahlam Arnaout
- International Wrist Centers-Clinique du Poignet, Bizet Clinic. 21, rue Georges Bizet, 75116, Paris, France
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Lee KH, Huang HK, Wang JP. A Modified Approach for Arthroscopic Excision of Dorsal Midcarpal Ganglion Cysts Using Radiocarpal Portals. Tech Hand Up Extrem Surg 2024; 28:12-15. [PMID: 37694879 DOI: 10.1097/bth.0000000000000452] [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: 09/12/2023]
Abstract
Wrist arthroscopy could be a treatment option for dorsal ganglion cysts. To achieve a thorough dorsal capsulectomy for the removal of midcarpal ganglion cysts, it is commonly necessary to combine both the radiocarpal and midcarpal portals. We present a modified method using radiocarpal portals only for arthroscopically excising dorsal midcarpal ganglion cysts. No extra midcarpal portals are necessary, and the method potentially generates satisfactory results.
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Affiliation(s)
- Kun-Han Lee
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Departments of Orthopaedics
| | - Hui-Kuang Huang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei
- Department of Orthopaedics, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi
- Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital
- Departments of Orthopaedics
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Smith NC, Yates SE, Mettyas T. Open Volar STT Ligament Reconstruction to Augment the Mathoulin's Arthroscopic Dorsal Capsuloligamentous Reconstruction: Technique Description and Case Reports. J Wrist Surg 2024; 13:66-74. [PMID: 38264128 PMCID: PMC10803145 DOI: 10.1055/s-0043-1768931] [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: 05/16/2022] [Accepted: 04/13/2023] [Indexed: 01/25/2024]
Abstract
Background The results of Mathoulin's arthroscopic dorsal capsuloligamentous reconstruction (ADCLR) are excellent in many patients with scapholunate instability, though less consistently good in higher grade instabilities. The purpose of this article is to describe a novel technique of volar scaphotrapeziotrapezoid (STT) reconstruction which may be used to augment rotational control of the scaphoid, in conjunction with the ADCLR, for use in European Wrist Arthroscopy Society (EWAS) grade IV/V instabilities. Description of Technique Following completion of ADCLR, the STT joint is approached through the flexor carpi radialis sheath. The palmaris longus tendon is harvested. Fluoroscopy is used to site guide wires for tunnel placement in the distal scaphoid and the proximal trapezium; 3.5-mm tunnels are overdrilled in both bones, to a depth of 8 mm. The palmaris graft is then anchored in the scaphoid tunnel with a mini-DX SwiveLock anchor. The graft is tensioned, then anchored in the trapezium tunnel with another anchor. Patients and Methods We retrospectively selected two young men heavy manual workers who had this procedure more than 12 months previously for scapholunate instability, with static radiographic abnormalities and a drive through sign (EWAS grade V). The patients were reviewed after 12 months, for assessment of visual analog scale, quick disabilities of the arm, shoulder, and hand, and patient-rated wrist/hand evaluation scores, range of motion, and grip strength. Results Both patients had marked improvements of wrist comfort and function at 1 year, and were able to return to their normal duties at work and complete all activities of daily living with minimal symptoms. Conclusion This volar STT reconstruction may expand the success of the Mathoulin's ADCLR into higher grade instabilities.
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Affiliation(s)
- Nicholas Charles Smith
- Macquarie Hand Unit, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
- Department of hand surgery, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
- Department of upper limb surgery and therapy, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Sally E. Yates
- Macquarie Hand Unit, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
- Department of upper limb surgery and therapy, Faculty of Medicine and Health Sciences, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Tamer Mettyas
- Macquarie Hand Unit, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
- Department of hand surgery, Macquarie University Hospital, Macquarie Park, New South Wales, Australia
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Prénaud C, Merlini L, de Villeneuve Bargemon JB, Gregory T, Dacheux C. Correlation between dorsal capsulo-scapholunate septum (DCSS) lesion and predynamic scapholunate instability. HAND SURGERY & REHABILITATION 2024; 43:101609. [PMID: 37879459 DOI: 10.1016/j.hansur.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE Scapholunate instability is the most common ligament injury of the wrist. In case of predynamic instability, diagnosis can be difficult, even under arthroscopy. Scapholunate instability is not the result of an isolated injury to the scapholunate interosseous ligament. Scapholunate stability is dependent not only on the scapholunate ligament, but on a complex that is comprising intrinsic and extrinsic ligaments. The dorsal capsule-scapholunate septum (DCSS) is one of the secondary stabilizers of the scapholunate complex. The objective of the present study was to investigate the correlation between DCSS lesion and predynamic scapholunate instability. METHOD A prospective multicenter study included patients who underwent wrist arthroscopy for traumatic wrist. Arthroscopic DCSS lesion stage and instability according to European Wrist Arthroscopy Society stage were assessed. RESULTS Twenty-seven subjects were included. We found a significant correlation between pathological DCSS and predynamic scapholunate instability and a correlation between DCSS lesion severity and instability level. CONCLUSION Isolated DCSS lesion should be considered a predictive factor for predynamic instability.
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Affiliation(s)
- Clément Prénaud
- Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France.
| | | | | | - Thomas Gregory
- Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
| | - Charles Dacheux
- Hôpital Avicenne, 125 Rue de Stalingrad, 93000 Bobigny, France
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Borrel F, Gras M, Arnaout A, Mathoulin C, Merlini L. Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears. J Wrist Surg 2023; 12:433-438. [PMID: 37841361 PMCID: PMC10569849 DOI: 10.1055/s-0043-1764159] [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: 07/29/2022] [Accepted: 01/24/2023] [Indexed: 10/17/2023]
Abstract
Background Many debates are still ongoing for the management of chronic scapholunate (SL) injuries. We have proposed an arthroscopic technique of dorsal capsulodesis with good clinical results. We now propose a radiological follow-up. Purpose To determine if arthroscopic dorsal capsulodesis can improve the radiographic SL angle and maintain this correction over time. Methods From January 2020 to January 2021, we included every patient with an SL instability and sorted them according to the European Wrist Arthroscopy Society (EWAS) classification. All patients had bilateral X-rays with a measurement of the radiolunate (RL) and SL angles for both the pathologic and healthy side. We also included patients with lunotriquetral or triangular fibrocartilage complex lesions. The exclusion criteria were the presence of arthritis and persistent intraoperative SL instability after capsulodesis. An arthroscopic dorsal capsulodesis was performed in all patients as originally described by Mathoulin. The RL and SL angles were then again measured on the immediate postoperative X-ray, and then again at 3, 6, and 12 months postoperatively. The statistical analysis was done using a paired Student's t -test with 145 degrees of freedom and α = 0.05. Results We included a total of 146 patients with a 1-year follow-up. Both the RL angle and the SL angles approach the healthy side at 12 months postoperatively. The RL angle has increased from -7.23 degrees to 4.37 degrees; the difference is still statistically significative, but it is almost equal to the healthy side (5.16 degrees). The SL angle has lowered from 74.55 to 54.95; the difference is still statistically and radiologically significative (6.788 degrees) but has been lowered by 74.3%. Conclusion This study shows that this technique can normalize the dorsal intercalated segment instability (DISI) over time without the need for any pinning or invasive ligament reconstructive surgery. Level of Evidence Level IV, cohort study. Clinical Relevance Dorsal capsulodesis should be considered in all reducible SL injuries, even when DISI is present.
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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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Amarasooriya M, Jerome TJ, Tourret L. Current Concepts in Scapholunate Instability Without Arthritic Changes. Indian J Orthop 2023; 57:515-526. [PMID: 37006727 PMCID: PMC10050294 DOI: 10.1007/s43465-023-00839-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/29/2023] [Indexed: 04/04/2023]
Abstract
Scapholunate instability (SLI) is the most common carpal instability described. SLI leads to a degenerative arthritic pattern known as scapholunate advanced collapse (SLAC). Diagnosis of SLI can be challenging in pre-dynamic and dynamic stages. CT arthrogram, MR arthrogram and dynamic fluoroscopy are helpful in diagnosis while arthroscopy remains the gold standard. SLI is a multi-ligament injury, which involves not only the scapholunate interosseous ligament (SLIL) but also the extrinsic carpal ligaments. Hence, it is better described as an injury compromising the 'dorsal scapholunate(dSLL) complex'. A repair can be attempted for acute SLI presenting within 6 weeks of injury. Reconstruction is the mainstay of treatment for chronic SLI without degenerative changes. Multiple repair techniques have been described which include capsulodesis and tenodesis procedures. The clinical outcomes of the techniques have improved over the years. However, a common problem of all these techniques is the lack of long-term data on the outcomes and deteriorating radiological parameters over time. SLI staging is an important factor to be considered in choosing the reconstruction techniques for a better outcome. Currently, there is a trend towards more biological and less invasive techniques. Regardless of the technique, it is important to preserve the nerve supply of the dorsal capsuloligamentous structures of the wrist. Arthroscopic techniques being minimally invasive have the advantage of less collateral damage to the capsuloligamentous structures. Rehabilitation involves a team approach where a protected dart thrower's motion is allowed after a period of immobilization. Strengthening SL-friendly muscles and inhibiting SL-unfriendly muscles is a key principle in rehabilitation.
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Affiliation(s)
- Melanie Amarasooriya
- Department of Orthopedic and Trauma Surgery, Flinders Medical Centre and Flinders University, Bedford Park, South Australia 5042 Australia
- Orthopedic Surgeon, Ministry of Health, Colombo, Sri Lanka
| | - Terrence Jose Jerome
- Hand and Reconstructive Microsurgery, Olympia Hospital and Research Centre , Trichy, India
| | - Lisa Tourret
- Hand and Upper Limb Surgeon, Brighton and Sussex University Hospitals, NHS Trust, Brighton, UK
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Kasapinova K, Kamiloski V, Atanasovska E, Spasovska K. Outcome Evaluation of Arthroscopic Resection of Dorsal Wrist Ganglia. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:145-153. [PMID: 36987765 DOI: 10.2478/prilozi-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Goals: Arthroscopic ganglionectomy has become an increasingly popular surgical option for dorsal wrist ganglia. The aim of this study was to describe our technique for the arthroscopic treatment of dorsal wrist ganglia and to evaluate the clinical results as well as the recurrence rate in our patients. Methods: In a prospective study, 48 patients who underwent arthroscopic treatment of dorsal ganglion of the wrist were included. Patients were evaluated preoperatively and 3 and 24 months post arthroscopy. A presence of recurrence at 24 months was recorded. The subjective outcome was evaluated with The Patient-Rated Wrist Evaluation (PRWE) and the Visual analog scale (VAS). Objective outcomes included grip strength and range of movement measurements. Results: The mean age was 36 years; the majority were women (36/48). Mean grip strength and the average flexion and extension in the wrist showed improvement after 3 months. The total PRWE score improved from 26.7 preoperatively to 10.2 at three months and 2.4 two years after surgery. After 24 months follow-up, there were only two patients with recurrence (4.2%). Conclusion: The arthroscopic resection of the dorsal wrist ganglia is a procedure with a low recurrence rate and lowest scaring and stiffness; it should be considered as a golden standard for operative treatment of the dorsal wrist ganglia.
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Affiliation(s)
- Katerina Kasapinova
- 1Medical Faculty, University "St.Cyril and Metodius", University Surgery Clinic "St.Naum Ohridski", Department of Traumatology, Skopje, RN Macedonia
| | - Viktor Kamiloski
- 1Medical Faculty, University "St.Cyril and Metodius", University Surgery Clinic "St.Naum Ohridski", Department of Traumatology, Skopje, RN Macedonia
| | - Emilija Atanasovska
- 2Medical Faculty, University "St.Cyril and Metodius", Institute for pharmacology and toxicology, Skopje, RN Macedonia
| | - Katerina Spasovska
- 3Medical Faculty, University "St.Cyril and Metodius", University Clinic for Infectious Diseases, Skopje, RN Macedonia
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Reiser D, Hedspång M, Sagerfors M. Dry Arthroscopy of the Wrist With a Single-use, 1.9 mm Chip-on-tip System in Wide-awake Local Anesthesia No Tourniquet. Tech Hand Up Extrem Surg 2022; 26:246-249. [PMID: 35698296 DOI: 10.1097/bth.0000000000000393] [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: 06/15/2023]
Abstract
We retrospectively reviewed our 34 first wrist dry arthroscopy cases using a single-use, 1.9 mm chip-on-tip system in wide-awake local anesthesia no tourniquet (WALANT). Thirteen patients were acute injuries; all acute patients underwent a magnetic resonance imaging (MRI) before arthroscopy. In total, 20 of 34 patients had a preoperative MRI. We use this method as a diagnostic tool in patients with wrist pain with suspected ligament tears and for the planning of treatment. We see 2 main advantages in the use of the needle chip-on-tip system: the simplicity of the procedure, and the minimal invasive character of the procedure due to the needle size that makes it possible to perform the procedure in WALANT. We find that the needle chip-on-tip arthroscopy system is a safe and cost-efficient alternative to wrist MRI with superior diagnostic ability. The procedure is minimally invasive and well suited for WALANT.
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Affiliation(s)
- Daniel Reiser
- Department of Hand Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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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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de Villeneuve Bargemon JB, Prenaud C, Quérel D, Bismuth Y, de Keyzer PB, Gras M. Repair of the dorsal capsuloligamentous scapholunate septum during arthroscopic resection of painful dorsal wrist ganglion cyst: Comparative analysis of two techniques. HAND SURGERY & REHABILITATION 2022; 41:457-462. [DOI: 10.1016/j.hansur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/25/2022]
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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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Abstract
The scapholunate ligament is made of 3 portions: proximal, volar, and dorsal. The latter is the major stabilizer of the scapholunar pair, and its lesion is bound to cause a destabilization of the carpus, as well as scapholunar diastasis, dorsal intercalated segment instability, then eventually SLAC (i.e., scapholunate advanced collapse) wrist. The healing process of this ligament, either spontaneous or after primary repair with direct suture, is rarely observed and a significant number of patients are diagnosed only at a late stage, thus making an illusion of a maintained stability of the carpus first range. Management then consists of ligamentoplasty. Several open techniques are described to restore stability, but at the cost of a frequent and significant tightening of the wrist. We will introduce here an arthroscopic ligamentoplasty technique completed by a posterior capsulodesis.
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Abstract
Carpal stability depends on the integrity of both intra-articular and intracapsular carpal ligaments. In this review, the role of the radial-sided and ulnar-sided extrinsic and intrinsic ligaments is described, as well as their advanced imaging using magnetic resonance arthrography (MRA) and contrast-enhanced magnetic resonance imaging (MRI) with three-dimensional (3D) scapholunate complex sequences and thin slices. In the last decade, the new concept of a so-called "scapholunate complex" has emerged among hand surgeons, just as the triangular ligament became known as the triangular fibrocartilage complex (TFCC).The scapholunate ligament complex comprises the intrinsic scapholunate (SL), the extrinsic palmar radiocarpal: radioscaphocapitate (RSC), long radiolunate (LRL), short radiolunate (SRL) ligaments, the extrinsic dorsal radiocarpal (DRC) ligament, the dorsal intercarpal (DIC) ligament, as well as the dorsal capsular scapholunate septum (DCSS), a more recently described anatomical structure, and the intrinsic palmar midcarpal scaphotrapeziotrapezoid (STT) ligament complex. The scapholunate (SL) ligament complex is one of the most involved in wrist injuries. Its stability depends on primary (SL ligament) and secondary (RSC, DRC, DIC, STT ligaments) stabilizers.The gold standard for carpal ligament assessment is still diagnostic arthroscopy for many hand surgeons. To avoid surgery as a diagnostic procedure, advanced MRI is needed to detect associated lesions (sprains, midsubstance tears, avulsions and chronic fibrous infiltrations) of the extrinsic, midcarpal and intrinsic wrist ligaments, which are demonstrated in this article using 3D and two-dimensional sequences with thin slices (0.4 and 2 mm thick, respectively).
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Bonczar T, Bonczar M, Pękala JR, Mann MR, Walocha JA. Innervation of the wrist joint: Literature review and clinical implications. Clin Anat 2021; 34:1081-1086. [PMID: 33905132 DOI: 10.1002/ca.23734] [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: 09/17/2019] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 11/11/2022]
Abstract
The aim of this study was to review the literature on the innervation of the wrist with an emphasis on pathological and therapeutic aspects. The nerves involved in wrist innervation and their mechanoreceptor endings are described. The literature over the past 30 years includes several topics that are still subjects of discussion and debate and require further research.
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Affiliation(s)
- Tomasz Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jakub R Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Mitchell R Mann
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
| | - Jerzy A Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,International Evidence-Based Anatomy Working Group, Krakow, Poland
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Mathoulin C, Merlini L, Taleb C. Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques. J Hand Surg Eur Vol 2021; 46:5-13. [PMID: 32954904 DOI: 10.1177/1753193420956319] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The management of scapholunate injuries and dissociation remains debatable. Traditional methods of fixation had centred around open procedures, but advances in wrist arthroscopic techniques has redefined both major anatomical findings and operative approaches. This article challenges two main existing dogmas: first, the anatomy of the scapholunate ligament and second, the management of these injuries. For the first, we propose that scapholunate stability is in fact maintained by a whole anatomic complex, consisting of well-defined capsuloligamentous structures and extrinsic ligaments, and that the scapholunate ligament itself probably has a limited role. For the second, we challenge the notion that scapholunate injuries often require open procedures and propose that mini-invasive arthroscopic dorsal repair of the scapholunate complex is an efficient technique and sufficient for achieving long-term stability.
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Affiliation(s)
| | | | - Chihab Taleb
- International Wrist Center, Clinique Bizet, Paris, France.,Chirurgie du Membre Supérieur, GHRMSA, Mulhouse, France.,Clinique des Trois Frontières, Saint Louis, France
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Carratalá V, Lucas FJ, Miranda I, Prada A, Guisasola E, Miranda FJ. Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results. J Wrist Surg 2020; 9:328-337. [PMID: 32760612 PMCID: PMC7395848 DOI: 10.1055/s-0040-1710502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/29/2020] [Indexed: 10/24/2022]
Abstract
Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained. Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded. Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.
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Affiliation(s)
- Vicente Carratalá
- Hand and Upper Limb Surgery Unit, Department of Orthopaedics, Hospital Quirónsalud Valencia, Valencia, Spain
| | - Francisco Javier Lucas
- Hand and Upper Limb Surgery Unit, Department of Orthopaedics, Hospital Quirónsalud Valencia, Valencia, Spain
| | - Ignacio Miranda
- Department of Orthopaedics, Hospital Universitari i Politècnic La Fe. Valencia, Spain
| | - Alfonso Prada
- Department of Orthopaedics, Hospital General de Villalba, Madrid, Spain
| | - Eva Guisasola
- Hand and Upper Limb Surgery Unit, Department of Orthopaedics, Hospital Quirónsalud Valencia, Valencia, Spain
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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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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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