Osteoligamentoplasty and limited dorsal capsulodesis for chronic scapholunate dissociation

Treatment of chronic scapholunate dissociation remains unsatisfactory. As the dorsal part of scapholunate interosseous ligament (SLIL) seems to be the "critical corner" of the scapholunate stability, its replacement by an analogous structure could restore scapholunate stability. A procedure is described which combines reconstruction of the dorsal region of the SLIL by means of an osteoligamentous autograft, harvested at the carpus (dorsal trapezoidometacarpal II ligament) and limited dorsal capsulodesis. The limited dorsal capsulodesis is performed using the scaphotriquetral head of the dorsal intercarpal ligament left attached to the distal pole of the scaphoid and fixed with a bone anchor on the dorsal aspect of the lunate. The osteoligamentous autograft prevents scapholunate dissociation and dorsal scaphoid subluxation. The dorsal capsulodesis limits scaphoid flexion and allows synergistic scapholunate mobility. This combination should stabilize the scaphoid in the horizontal as well as sagittal planes. The advantages of this technique are: 1) a single incision; 2) replacement of a ligament by an analogous autograft; 3) faster healing by bone-to-bone apposition; 4) more anatomic and physiologic reconstruction. Three patients are presented to illustrate the technique.