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Scapholunate stabilization with dynamic extensor carpi radialis longus tendon transfer.

Steven L Peterson1, Alan E Freeland

  • 1Operative Care Division, Portland Veterans Administration Medical Center, Portland, OR 97201, USA. slpdvmmd@aol.com

The Journal of Hand Surgery
|December 8, 2010
PubMed
Summary

Dynamic extensor carpi radialis longus tendon transfer restores scaphoid motion after scapholunate interosseous ligament injury. This surgical technique may be sufficient for dynamic instability and aids ligament repair for better wrist function.

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Area of Science:

  • Orthopedic Surgery
  • Biomechanics
  • Hand Surgery

Background:

  • Scapholunate interosseous ligament (SLIL) injuries disrupt wrist biomechanics, leading to instability and pain.
  • Traditional treatments like capsulodesis and tenodesis have limitations in restoring natural wrist motion.
  • Dynamic scapholunate instability requires dynamic stabilization to restore the scaphoid's slider-crank mechanism.

Observation:

  • The extensor carpi radialis longus (ECRL) tendon transfer to the scaphoid mimics a dorsal radioscaphoid ligament.
  • This dynamic transfer aims to replicate normal viscoelastic forces during wrist motion.
  • ECRL transfer can act synchronously and synergistically with existing wrist movements.

Findings:

  • ECRL transfer alone may suffice for partial SLIL tears with dynamic scapholunate instability, supporting normal kinematics.

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  • For static instability, ECRL transfer improves carpal congruity but requires concurrent SLIL and dorsal lunate ligament repair for durable results.
  • The procedure offers a simpler alternative to capsulodesis/tenodesis, avoiding intercarpal fixation and allowing faster rehabilitation.

    • Implications:

    • ECRL tendon transfer presents a viable, less invasive option for managing SLIL injuries and associated wrist instability.
    • This technique holds potential for improving patient outcomes and accelerating recovery in specific wrist injury cases.
    • Further research can explore long-term efficacy and optimal patient selection for ECRL transfer in wrist reconstruction.