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Arthroscopic-Assisted Combined Dorsal and Volar Scapholunate Ligament Reconstruction with Tendon Graft for Chronic SL Instability

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Wrist and Elbow Arthroscopy with Selected Open Procedures

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Abstract

Both the dorsal and volar portions of the scapholunate interosseous ligament (SLIL) are major stabilizers of the scapholunate (SL) joint. Most reconstruction methods to restore SL stability do not address the volar constraints and frequently fail to reduce the SL gapping. With the assistance of arthroscopy and intraoperative imaging as a guide, a combined limited dorsal and volar incision exposed the dorsal and palmar SL interval without violating the wrist joint capsule. Bone tunnels were made on the proximal scaphoid and lunate. A palmaris longus tendon graft was delivered through the wrist capsule and the bone tunnels to reduce and connect the two bones in a box-like fashion. Once the joint diastasis was reduced and any DISI malrotation corrected, the tendon graft was knotted and sutured on the dorsal surface of the SL joint extracapsularly in a shoe-lacing manner. The scaphocapitate joint was transfixed with Kirschner wires (K-wires) to protect the reconstruction for 6–8 weeks. We have satisfactory results in our 17 patients in terms of pain, range of motion, and grip strength. Recurrence of a DISI deformity was noted in four patients without symptoms. Ischemic change of proximal scaphoid was noted in one case without symptoms or progression. There were no major complications. All patients were satisfied with the procedure and outcome.

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References

  1. Daniels JM II, Zook EG, Lynch JM. Hand and wrist injuries: part I. Nonemergent evaluation. Am Fam Phys. 2004;69(8):1941–8.

    Google Scholar 

  2. Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am. 1980;5(3):226–41.

    Article  CAS  Google Scholar 

  3. Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am. 2007;32:297–309.

    Article  Google Scholar 

  4. Peterson HA, Lipscomb PR. Intercarpal arthrodesis. Arch Surg. 1967;95:127–34.

    Article  CAS  Google Scholar 

  5. Palmer AK, Dobyns JH, Linscheid RL. Management of post- traumatic instability of the wrist secondary to ligament rupture. J Hand Surg Am. 1978;3:507–32.

    Article  CAS  Google Scholar 

  6. Uematsu A. Intercarpal fusion for treatment of carpal instability: a preliminary report. Clin Orthop Relat Res. 1979;144:159–65.

    Google Scholar 

  7. Watson HK. Limited wrist arthrodesis. Clin Orthop Relat Res. 1980;149:126–36.

    Google Scholar 

  8. Glickel SZ, Millender LH. Ligamentous reconstruction for chronic intercarpal instability. J Hand Surg Am. 1984;9:514–27.

    Article  CAS  Google Scholar 

  9. Hastings DE, Silver RL. Intercarpal arthrodesis in the management of chronic carpal instability after trauma. J Hand Surg Am. 1984;9:834–40.

    Article  CAS  Google Scholar 

  10. 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.

    Article  CAS  Google Scholar 

  11. Conyers DJ. Scapholunate interosseous reconstruction and imbrication of palmar ligaments. J Hand Surg Am. 1990;15:690–700.

    Article  CAS  Google Scholar 

  12. Almquist EE, Bach AW, Sack JT, Fuhs SE, Newman DM. Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation. J Hand Surg Am. 1991;16:322–7.

    Article  CAS  Google Scholar 

  13. Pisano SM, Peimer CA, Wheeler DR, Sherwin F. Scaphocapitate intercarpal arthrodesis. J Hand Surg Am. 1991;16:328–33.

    Article  CAS  Google Scholar 

  14. Rotman MB, Manske PR, Pruitt DL, Szerzinski J. Scaphocapitolunate arthrodesis. J Hand Surg Am. 1993;18:26–33.

    Article  CAS  Google Scholar 

  15. Brunelli GA, Brunelli GR. A new surgical technique for carpal instability with scapho-lunar dislocation. (Eleven cases). Ann Chir Main Memb Super. 1995;14:207–13.

    CAS  PubMed  Google Scholar 

  16. Wintman BI, Gelberman RH, Katz JN. Dynamic scapholunate instability: results of operative treatment with dorsal capsulodesis. J Hand Surg Am. 1995;20:971–9.

    Article  CAS  Google Scholar 

  17. Rosenwasser MP, Miyasajsa KC, Strauch RJ. The RASL procedure: reduction and association of the scaphoid and lunate using the Herbert screw. Tech Hand Up Extrem Surg. 1997;1:263–72.

    Article  CAS  Google Scholar 

  18. Uhl RL, Williamson SC, Bowman MW, Sotereanos DG, Osterman AL. Dorsal capsulodesis using suture anchors. Am J Orthop. 1997;26:547–8.

    CAS  PubMed  Google Scholar 

  19. Van Den Abbeele KL, Loh YC, Stanley JK, Trail IA. Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg Br. 1998;23:258–61.

    Article  Google Scholar 

  20. Weiss AP. Scapholunate ligament reconstruction using a bone- retinaculum-bone autograft. J Hand Surg Am. 1998;23:205–15.

    Article  CAS  Google Scholar 

  21. Harvey EJ, Hanel DP. Bone-ligament-bone reconstruction for sca- pholunate disruption. Tech Hand Up Extrem Surg. 2002;6:2–5.

    Article  Google Scholar 

  22. Moran SL, Ford KS, Wulf CA, Cooney WP. Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg Am. 2006;31(9):1438–46.

    Article  Google Scholar 

  23. Darlis NA, Kaufmann RA, Giannoulis F, Sotereanos DG. Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability. J Hand Surg Am. 2006;31:418–24.

    Article  Google Scholar 

  24. Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am. 2006;31:125–34.

    Article  Google Scholar 

  25. Aviles AJ, Lee SK, Hausman MR. Arthroscopic reduction-association of the scapholunate. Arthroscopy. 2007;23:105.e1–5.

    Article  Google Scholar 

  26. Papadogeorgou E, Mathoulin C. Extensor carpi radialis brevis ligamentoplasty and dorsal capsulodesis for the treatment of chronic post-traumatic scapholunate instability. Chir Main. 2010;29:172–9.

    Article  CAS  Google Scholar 

  27. Mathoulin CL, Dauphin N, Wahegaonkar AL. Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears. Hand Clin. 2011;27:563–72.

    Article  Google Scholar 

  28. Camus EJ, Van Overstraeten L. Dorsal scapholunate stabilization using Viegas’ capsulodesis: 25 cases with 26 months-follow-up. Chir Main. 2013;32:393–402.

    Article  CAS  Google Scholar 

  29. Ross M, Couzens G. A new technique for scapholunate ligament reconstruction utilizing FCR and interference screw fixation. J Hand Surg Am. 2013;38(Suppl):e51.

    Article  Google Scholar 

  30. Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am. 1999;24:953–62.

    Article  CAS  Google Scholar 

  31. Berger RA. The ligaments of the wrist. A current overview of anatomy with considerations of their potential functions. Hand Clin. 1997;13:63–82.

    Article  CAS  Google Scholar 

  32. Yi IS, Firoozbakhsh K, Racca J, Umeda Y, Moneim M. Treatment of scapholunate dissociation with palmaris longus tendon graft: a biomechanical study. Univ Pennsylvania Orthop J. 2000;13:53–9.

    Google Scholar 

  33. Zdero R, Olsen M, Elfatori S, Skrinskas T, Nourhosseini H, Whyne C, et al. Linear and torsional mechanical characteristics of intact and reconstructed scapholunate ligaments. J Biomech Eng. 2009;131(4):41009.

    Article  Google Scholar 

  34. Dobyns JH, Linscheid RL, EYS C, Weber ER, Swanson GE. Traumatic instability of the wrist In Instructional Course Lectures, The American Academy of Orthopaedic Surgeons, vol. 24. St. Louis: C. V. Mosby; 1975. p. 182–99.

    Google Scholar 

  35. Ho PC, Wong WYC, Tse WL. Arthroscopic-assisted combined dorsal and volar scapholunate ligament reconstruction with tendon graft for chronic SL instability. J Wrist Surg. 2015;4(4):252–63.

    Article  Google Scholar 

  36. Koo SC, Ho PC. Wrist arthroscopy under portal site local anesthesia without tourniquet and sedation. Hand Clin. 2017;33(4):585–91.

    Article  Google Scholar 

  37. Naqui Z, Khor WS, Mishra A, Lees V, Muir L. The management of chronic non-arthritic scapholunate dissociation: a systematic review. J Hand Surg Eur Vol. 2018;43(4):394–401.

    Article  Google Scholar 

  38. Salva-Coll G, Garcia-Elias M, Hagert E. Scapholunate instability: proprioception and neuromuscular control. J Wrist Surg. 2013;2(2):136–40.

    Article  Google Scholar 

  39. Hagert E, Lluch A, Rein S. The role of proprioception and neuromuscular stability in carpal instabilities. J Hand Surg Eur Vol. 2016;41(1):94–101.

    Article  CAS  Google Scholar 

  40. Koo SC, Ho PC. Arthroscopic-assisted Box Reconstruction of scapho-lunate ligament with tendon graft. In Mathoulin C, Ed. Wrist Arthroscopy Techniques. Stuttgart, Germany; 2019:87–92.

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China

    Siu-cheong Jeffrey Justin Koo

  2. Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Hong Kong, China

    Pak-cheong Ho

Authors
  1. Siu-cheong Jeffrey Justin Koo
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  2. Pak-cheong Ho
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Correspondence to Pak-cheong Ho .

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Editors and Affiliations

  1. Division of Hand and Upper Extremity Surgery Section of Arthroscopic Surgery and Sports Medicine, Department of Orthopedic Surgery and Rehabilitation, University of Mississippi Medical Center, Jackson, MS, USA

    William B. Geissler

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Koo, Sc.J.J., Ho, Pc. (2022). Arthroscopic-Assisted Combined Dorsal and Volar Scapholunate Ligament Reconstruction with Tendon Graft for Chronic SL Instability. In: Geissler, W.B. (eds) Wrist and Elbow Arthroscopy with Selected Open Procedures. Springer, Cham. https://doi.org/10.1007/978-3-030-78881-0_15

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  • DOI: https://doi.org/10.1007/978-3-030-78881-0_15

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78880-3

  • Online ISBN: 978-3-030-78881-0

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