Modified Viegas dorsal capsuloplasty for chronic partial injury of the scapholunate ligament in young athletes: outcomes at 24 months

Scapholunate Ligament Injuries

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.

Combined repair of scapholunate ligament (SL) and triangular fibrocartilage complex (TFCC) lesions in chronic trauma of the wrist: surgical treatment of 14 patients

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.

Comparison of Outcomes of Scapholunate Ligament Reconstruction Techniques

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.

Dorsal scapholunate interosseous ligament: ultrasound evaluation between dominant and non-dominant wrist in young sports patients

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.