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Arthroscopic gap distance can predict the degree of scapholunate ligament tears: a cadaver study

  • Original Article
  • Published:
Journal of Orthopaedic Science

Abstract

Background

Midcarpal joint arthroscopy is essential for diagnosing scapholunate (SL) instability, but a discrepancy may exist between the grade of arthroscopic evaluation and the extent of SL ligament tears. This study aimed to investigate whether the magnitude of arthroscopic SL gap distance could predict the extent of ligamentous disruptions in a simulated SL dissociation model.

Methods

Eight upper extremities of fresh cadavers were analyzed. Static and dynamic SL gap distances were measured with using custom-made probes via midcarpal arthroscopy in intact wrists following sequential sectioning of the SL stabilizing ligaments. Comparisons of static and dynamic SL gaps between stages were conducted using analysis of variance followed by the Games–Howell test. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic performance of the SL gap distance in identifying simulated ligament tears.

Results

There were no significant differences between stages in the static SL gap distance. Dynamic SL gap distance increased significantly following SL interosseous ligament (SLIL) sectioning. According to the ROC curve for dynamic SL gap distance, the area under the curve was 0.94 for the assessment of the diagnostic performances in identifying complete SLIL sectioning. A cut-off value of 1.4 mm for the dynamic SL gap showed the highest diagnostic accuracy rate (91%). The dynamic SL gap distance showed a high diagnostic performance in the detection of dorsal intercarpal ligament (DICL) sectioning. The highest accuracy rate (85%) was noted when the threshold value was set at 2.8 mm.

Conclusion

The SLIL is the primary stabilizer of the SL joint in the viewpoint of arthroscopic measurement. Dynamic SL joint widening of more than 1.4 mm showed the best predictive ability for complete SLIL tears, while 2.8 mm widening made it possible to predict both DICL and SLIL tears.

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Acknowledgments

We would like to acknowledge Mr. Daisuke Suzuki, Dr. Tomoaki Kamiya, Dr. Keiichi Murata, and Dr. Jun Yoshida for their valuable help in this study.

Conflict of interest

We have no conflict of interest of any form in support of the research or the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan

    Yoshihiro Dohi, Shohei Omokawa, Hiroshi Ono & Yasuhito Tanaka

  2. Department of Orthopedic Surgery, Sapporo-Daiichi Hospital, 4-26 Shijo-sancho, Nishi-ku, Sapporo, 063-0804, Japan

    Mitsuhiro Aoki

  3. Department of Public Health, Health Management Policy, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan

    Manabu Akahane

  4. Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-Nishi 17, Chuo-ku, Sapporo, 060-8556, Japan

    Takuro Wada

  5. Department of Anatomy 2, Sapporo Medical University, Minami 1-Nishi 17, Chuo-ku, Sapporo, 060-8556, Japan

    Mineko Fujimiya

  6. 2-15-9 Kitayamato, Ikoma, Nara, 630-0121, Japan

    Shohei Omokawa

Authors
  1. Yoshihiro Dohi
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  2. Shohei Omokawa
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  3. Hiroshi Ono
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  5. Manabu Akahane
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  7. Mineko Fujimiya
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  8. Yasuhito Tanaka
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Correspondence to Shohei Omokawa.

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Dohi, Y., Omokawa, S., Ono, H. et al. Arthroscopic gap distance can predict the degree of scapholunate ligament tears: a cadaver study. J Orthop Sci 17, 64–69 (2012). https://doi.org/10.1007/s00776-011-0172-x

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  • DOI: https://doi.org/10.1007/s00776-011-0172-x

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