Midterm Outcome of Bone-Ligament-Bone Graft and Dorsal Capsulodesis for Chronic Scapholunate Instability

To assess midterm outcomes of our bone-ligament-bone (BLB) grafts for chronic scapholunate (SL) instability and better define criteria for their use.

We conducted a retrospective review of 26 patients treated with BLB grafts and dorsal capsulodesis between 1997 and 2009. Twenty-four patients were reviewed. Mean follow-up was 8.2 years. Two patients had dynamic lesions, 7 had SL dissociation, 14 had a dorsal intercalated segment instability lesion, and 1 had SL advanced collapse stage 1. Mean age at surgery was 46 years. All patients presented with pain and 14 had lack of strength. Results were reviewed clinically and radiologically. Images were assessed by 4 surgeons and 1 radiologist for radial styloid, radioscaphoid, radiolunate, midcarpal, and scaphotrapeziotrapezoid degenerative changes.

Five patients needed subsequent 4-corner arthrodesis. Of the remaining 19 patients at follow-up, both extension and flexion decreased to 73% of the contralateral side. Postoperative grip strength improved from 78% to 90% of the nonsurgical wrist. Quick Disabilities of the Arm, Shoulder, and Hand score was 10 of 100 and the Patient-Rated Wrist Evaluation score was 10 of 100. Radiologically, the SL gap was improved and maintained at follow-up. The SL angle (mean before surgery, 79°) was initially corrected to 69° but returned to preoperative values at follow-up. Eleven of the 19 cases had signs of midcarpal arthritis.

Bone-ligament-bone grafts with SL dorsal capsulodesis were able to restore and maintain an improved SL interval in all patients. The technique achieved good clinical results and high patient satisfaction, but it did not stop the progression of arthritis, particularly at the midcarpal level. This technique is an option for isolated unrepairable lesion of the dorsal SL ligament with an easily correctable lunate and especially when restoration of grip strength is important.

Therapeutic IV.