Equivalent Clinical Outcomes Following Favored Treatments of Chronic Scapholunate Ligament Tear

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

  1. 1.

    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.

    Article  Google Scholar 

  2. 2.

    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.

    Article  Google Scholar 

  3. 3.

    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.

    CAS  PubMed  Google Scholar 

  4. 4.

    Blevens AD, Light TR, Jablonsky WS, et al. Radiocarpal articular contact characteristics with scaphoid instability. J Hand Surg. 1989; 14: 781–790.

    CAS  Article  Google Scholar 

  5. 5.

    Burgess RC. The effect of rotatory subluxation of the scaphoid on radio-scaphoid contact. J Hand Surg. 1987; 12: 771–774.

    CAS  Article  Google Scholar 

  6. 6.

    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.

    Article  Google Scholar 

  7. 7.

    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.

    Article  PubMed  Google Scholar 

  8. 8.

    Deshmukh SC, Givissis P, Belloso D. Blatt’s capsulodesis for chronic scapholunate dissociation. J Hand Surg. 1999; 24: 215–220.

    CAS  Article  Google Scholar 

  9. 9.

    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.

    Article  Google Scholar 

  10. 10.

    Frank N. Treatment of static scapholunate instability with modified Brunelli Tenodesis: results over 10 years. J Hand Surg. 2013; 38: 887–892.

    Article  Google Scholar 

  11. 11.

    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.

    Article  Google Scholar 

  12. 12.

    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.

    Article  Google Scholar 

  13. 13.

    Kuo CE, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg. 2008; 33: 998–1013.

    Article  Google Scholar 

  14. 14.

    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.

    Article  Google Scholar 

  15. 15.

    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.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. Hand. 2013; 8: 146–156.

    Article  PubMed  PubMed Central  Google Scholar 

  17. 17.

    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.

    CAS  Article  Google Scholar 

  18. 18.

    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.

    Article  Google Scholar 

  19. 19.

    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.

    Article  Google Scholar 

  20. 20.

    Steven LM, William PC, Richard AB, Justin S. Capsulodesis for the treatment of chronic scapholunate instability. J Hand Surg. 2005; 30: 16–23.

    Article  Google Scholar 

  21. 21.

    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.

    Article  Google Scholar 

  22. 22.

    Taleisnik J. Current concepts review. Carpal instability. J Bone Joint Surg. 1988; 70: 1262–1268.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Watson HK, Brenner LH. Degenerative disorders of the wrist. J Hand Surg. 1985; 10: 1002–1006.

    CAS  Article  Google Scholar 

  24. 24.

    Wintman BI, Gelberman RH, Katz JN. Dynamic scapholunate instability: results of operative treatment with dorsal capsulodesis. J Hand Surg. 1995; 20: 971–979.

    CAS  Article  Google Scholar 

  25. 25.

    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.

    CAS  Article  Google Scholar 

  26. 26.

    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.

    Article  Google Scholar 

  27. 27.

    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.

    Article  Google Scholar 

  28. 28.

    Zyluk A, Piotuch B. The management of scapholunate wrist instability: a review. Pol Orthop Traumatol. 2012; 77: 83–89.

    PubMed  Google Scholar 

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Correspondence to Daniel A. Osei MD, MSc.

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Conflict of Interest

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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Keywords

  • scapholunate
  • scapholunate ligament
  • repair
  • capulodesis
  • tenodesis
  • reconstruction
  • brunelli