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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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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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Della Rosa N, Vita F, Pederiva D, Pilla F, Donati D, Faldini C, Adani R. Combined repair of scapholunate ligament (SL) and triangular fibrocartilage complex (TFCC) lesions in chronic trauma of the wrist: surgical treatment of 14 patients. Musculoskelet Surg 2024; 108:69-75. [PMID: 37227663 DOI: 10.1007/s12306-023-00787-w] [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] [Received: 01/12/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Injuries of the scapholunate ligament (SL) and of the triangular fibrocartilage complex (TFCC) represent the main ligament injuries of the traumatic wrist. A double injury of the SL and TFCC ligaments is quite common in the trauma setting, and clinical examination is fundamental. MRI allows to detection of a TFCC and SL ligament injury, but wrist arthroscopy is still the gold standard for diagnosis. We present the clinical results of the combined reconstruction of chronic scapholunate ligament and TFCC injury. MATERIALS AND METHODS Fourteen patients were treated at our hospital with a combined scapholunate ligament and TFCC complex repair. All patients were surgically treated by the same senior author, after a diagnostic arthroscopy that revealed a lesion of both structures. A comparison between the pre-operative and post-operative pain and function was carried out using VAS, Disability of Arm, Shoulder and Hand score (DASH) and Patient-Related Wrist/Hand Evaluation score (PRWHE). Wrist range of motion and strength were also compared following surgery. RESULTS All patients had a mean follow-up of 54 months. A statistically significant improvement was observed both with the reduction in pain (VAS from 8.9 to 5) and with the improvement of functionality scores (DASH from 63 to 40 and PRWHE from 70 to 57) and with the increase in ROM and strength. In only one patient (7%), because of pain and instability, a supplement operation was needed (Sauve-Kapandji procedure) 3 months after the initial surgery. CONCLUSIONS The simultaneous repair of the SL and TFCC complex has shown a good success rate in both decreasing pain and regaining functionality.
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Affiliation(s)
- Norman Della Rosa
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Fabio Vita
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy.
| | - Davide Pederiva
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Federico Pilla
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Danilo Donati
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Cesare Faldini
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Roberto Adani
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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Wu M, Ilyas A. Comparison of Outcomes of Scapholunate Ligament Reconstruction Techniques. J Wrist Surg 2023; 12:558-568. [PMID: 38213567 PMCID: PMC10781577 DOI: 10.1055/s-0042-1757442] [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: 01/07/2022] [Accepted: 08/01/2022] [Indexed: 11/21/2022]
Abstract
Introduction Injury to the scapholunate interosseous ligament (SLIL) is a common cause of carpal instability, yet surgical management of chronic SLIL disruption remains challenging with no optimal technique identified. Purpose The purpose of this meta-analysis was to comparatively review the available evidence of clinical, radiographic, and patient-reported outcome measures among popular techniques of SLIL reconstruction (capsulodesis, tenodesis, and bone-tissue-bone graft) to better guide management of SLIL injuries. Methods A total of 1,172 patients from 42 included studies were assessed. Standardized data extraction and analysis were performed. The mean of postoperative outcome assessments with standard deviation was used to calculate pooled standardized mean difference with 95% confidence interval. Results Visual Analog Scale (VAS) score for postoperative pain was lowest in bone-tissue-bone patients at 0.9 ( p = 0.0360). Bone-tissue-bone patients had the highest percentage of "excellent" functional outcomes at 64.5% ( p < 0.0001). Disabilities of the Arm, Shoulder, and Hand (DASH)/QuickDASH score was best in bone-tissue-bone patients at 9.7 ( p < 0.0001). Patient-Rated Wrist Evaluation (PRWE) score was best in tenodesis patients at 37.8 ( p = 0.0255). There were no statistically significant differences in grip strength, range of motion, or radiographic outcomes among the techniques. Conclusion Existing data demonstrate some benefit of bone-tissue-bone reconstruction over capsulodesis and tenodesis in pain reduction and functional improvement of the injured wrist. No statistically significant differences among radiographic outcomes could be ascertained, possibly attributable to the heterogeneity of procedures. This review provides an updated reference and highlights the need for multicenter trials with longer term follow-up and more standardized outcome measures.
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Affiliation(s)
- Meagan Wu
- Department of Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Asif Ilyas
- Division of Hand and Upper Extremity Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania
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Fabio V, Danilo D, Cesare F, Stefano G, Roberto A, Norman DR. Dorsal scapholunate interosseous ligament: ultrasound evaluation between dominant and non-dominant wrist in young sports patients. J Ultrasound 2022; 25:579-584. [PMID: 35092602 PMCID: PMC9402840 DOI: 10.1007/s40477-021-00626-3] [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] [Received: 07/18/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The dorsal component of the scapholunate ligament, is the strongest component, in fact it has a maximum tensile strength of 300 N and mainly controls flexion and extension. In a recent study, the thickness and length of the dorsal component of SLIL was measured using ultrasound image, the length of the dorsal scapholunate ligament was 7.5 mm ± 1.4 mm and the thickness of 1.8 mm ± 0.4 mm. We evaluate 60 wrists of 30 young athletic volunteers with ultra-sound image, comparing the thickness variations of the dorsal component of SLIL between the dominant and non-dominant wrist, to confirm our hypothesis that the dorsal component SLIL has proprioceptive activity and therefore the thickness of the ligament increases in following wrist activity. METHODS With a high-frequency ultrasound probe > 15 MHz (Sonoscape X3 Pro) we evaluated 60 wrists of 30 young men (16 males and 14 females, 20-38 years old) manual sports volunteers (10 tennis players, 8 padel players, 7 swimmers, 5 weight lifters) with no recent ligament injuries of the hand or wrist to participate in the study, we compared the dorsal component of SLIL between the dominant and non-dominant wrist. RESULTS Dorsal SLIL was visualized in all 60 volunteers wrists. We measured an average scapholunate dorsal ligament length 7.7 mm and average thickness of 2.3 mm in the dominant wrist and average 7.2 mm in length and average 1.9 mm thickness in the non dominant wrist. The mean dorsal scapholunate interval was average 4.9 mm and the mean central interval was average 2.1 mm in the dominant wrist and 4.7 mm and 1.8 mm in the non dominant wrist, so that meas-urements remained unchanged with those reported by previous authors. CONCLUSIONS In our study we ultrasonographically measured an average scapholunate dorsal ligament length 7.7 mm and average thickness of 2.3 mm in the dominant wrist and average 7.2 mm in length and average 1.9 mm thickness in the non dominant wrist. This confirms our hypothesis that there is a direct stimulus on the ligamentous component of the dor-sal SLIL in the dominant wrist following repeated uses and activities such as to cause an increase in thickness of the dorsal ligament to highlight the possibility of a proprioceptivity of the ligament if subjected to continuous training. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Vita Fabio
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy.
| | - Donati Danilo
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Faldini Cesare
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Galletti Stefano
- IRCCS-Rizzoli Orthopedic Institute, University of Bologna, Via Pupilli 1, 40136, Bologna, Italy
| | - Adani Roberto
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
| | - Della Rosa Norman
- Department of Hand Surgery and Microsurgery, University Hospital of Modena, Modena, Italy
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