Abstract
Background
Optimal treatment of chronic scapholunate (SL) instability remains controversial. Many surgical techniques have been proposed with varied results in subsequent case series; however, there is limited evidence demonstrating the relative effectiveness of the different treatment options.
Questions/Purposes
We conducted a systematic review of the English literature to compare outcomes from capsulodesis and ligament reconstruction for treatment of chronic scapholunate instability.
Methods
An electronic database search using keywords associated with scapholunate ligament instability was performed. A total of 511 studies were identified. All studies with scapholunate ligament tears >4 weeks after the initial injury were included in the review. Data extracted included patient demographics, wrist range of motion, and radiographic outcome measures.
Results
A total of 308 patients from 11 studies met the inclusion criteria and were included in the study. The average time to surgery from initial injury was 11 months. There was no significant difference in wrist flexion or extension after capsulodesis or reconstruction. The weighted mean for postoperative wrist extension/flexion was 56°/45.6° in the capsulodesis group and 40.9°/47.3° in the reconstruction group. Pooled means of SL angle and SL gap were 60.3° and 3.44 mm after capsulodesis and 56.5 and 2.72 mm after reconstruction, respectively.
Conclusions
This systematic review failed to demonstrate any significant difference in outcomes from capsulodesis or reconstruction for treatment of chronic scapholunate instability. However, the retrospective studies examined were notably heterogeneous in design with high estimates of variance. Further prospective trials are necessary to determine an ideal treatment strategy.
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References
Andreas S, Regula S. Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid. J Hand Surg. 2002; 27: 674–684.
Annie CL, Simon HC, Thanapong W, Thomas ET. Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg. 2008; 33: 850–856.
Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin. 1987; 3: 81–102.
Blevens AD, Light TR, Jablonsky WS, et al. Radiocarpal articular contact characteristics with scaphoid instability. J Hand Surg. 1989; 14: 781–790.
Burgess RC. The effect of rotatory subluxation of the scaphoid on radio-scaphoid contact. J Hand Surg. 1987; 12: 771–774.
Chabas J-F, Gay A, Valenti D, Guinard D, Legre R. Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients. J Hand Surg. 2008; 33: 1469–1477.
De Carli P, Donndorff AG, Gallucci GL, Boretto JG, Alfie VAA. Chronic scapholunate dissociation: ligament reconstruction combining a new extensor carpi radialis longus tenodesis and a dorsal intercarpal ligament capsulodesis. Tech Hand Up Extrem Surg. 2011; 15: 6–11.
Deshmukh SC, Givissis P, Belloso D. Blatt’s capsulodesis for chronic scapholunate dissociation. J Hand Surg. 1999; 24: 215–220.
Eric MR, Julie A, Matthew DP, Julie EA. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg. 2014; 39: 2020–2026.
Frank N. Treatment of static scapholunate instability with modified Brunelli Tenodesis: results over 10 years. J Hand Surg. 2013; 38: 887–892.
Gajendran VK, Peterson B, Slater RR Jr, Szabo RM. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation. J Hand Surg. 2007; 32: 1323–1333.
Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg. 2006; 31: 125–134.
Kuo CE, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg. 2008; 33: 998–1013.
Moran SL, Ford KS, Wulf CA, Cooney WP. Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg. 2006; 31: 1438–1446.
Papadogeorgou E, Mathoulin C. Extensor carpi radialis brevis ligamentoplasty and dorsal capsulodesis for the treatment of chronic post-traumatic scapholunate instability. Chir Main. 2010; 29: 172–179.
Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. Hand. 2013; 8: 146–156.
Pauchard N, Dederichs A, Segret J, Barbary S, Dap F, Dautel G. The role of three-ligament tenodesis in the treatment of chronic scapholunate instability. J Hand Surg. 2013; 38: 758–766.
Pomerance J. Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma. J Hand Surg. 2006; 31: 1380–1386.
Steve KL, Dan AZ, Anthony S, Raj K, Jeffrey Y. Biomechanical comparison of 3 methods of scapholunate ligament reconstruction. J Hand Surg. 2014; 39: 643–650.
Steven LM, William PC, Richard AB, Justin S. Capsulodesis for the treatment of chronic scapholunate instability. J Hand Surg. 2005; 30: 16–23.
Szabo RM, Slater RR, Palumbo CF, Gerlach T. Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results. J Hand Surg. 2002; 27: 978–984.
Taleisnik J. Current concepts review. Carpal instability. J Bone Joint Surg. 1988; 70: 1262–1268.
Watson HK, Brenner LH. Degenerative disorders of the wrist. J Hand Surg. 1985; 10: 1002–1006.
Wintman BI, Gelberman RH, Katz JN. Dynamic scapholunate instability: results of operative treatment with dorsal capsulodesis. J Hand Surg. 1995; 20: 971–979.
Wyrick JD, Youse BD, Kiefhaber TR. Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation. J Hand Surg. 1998; 23: 776–780.
Yong Y, Kannan K, Tsu-Min T. Radiographic evaluation of chronic static scapholunate dissociation post soft tissue reconstruction. J Wrist Surg. 2013; 02: 155–159.
Zarkadas PC, Gropper PT, White NJ, Perey BH. A survey of the surgical management of acute and chronic scapholunate instability. J Hand Surg. 2004; 29: 848–857.
Zyluk A, Piotuch B. The management of scapholunate wrist instability: a review. Pol Orthop Traumatol. 2012; 77: 83–89.
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Pengcheng Wang, MD, Jeffrey G. Stepan, MD, and Tonya An, MD, MA have declared that they have no conflict of interest. Daniel A. Osei, MD reports grants from NIH/NCATS KL2 TR000450 and grants from BJHF/ICTS Pilot Award, outside the work.
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Work performed at Washington University in St Louis School of Medicine.
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Wang, P., Stepan, J.G., An, T. et al. Equivalent Clinical Outcomes Following Favored Treatments of Chronic Scapholunate Ligament Tear. HSS Jrnl 13, 186–193 (2017). https://doi.org/10.1007/s11420-016-9525-5
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DOI: https://doi.org/10.1007/s11420-016-9525-5