[Scapholunate lesions and instabilities--how to recognize and treat them?]

The lesions of the scapholunate ligament are some of the most frequently encountered in the wrist. Left untreated, the complete rupture of the ligament is followed by degenerative arthritis according to a well-defined pattern of progression through the wrist, eventually leading to multifocal arthrosis, a condition described as scapholunate advanced collapse (SLAC wrist). The scapholunate lesions are classified in stages according to the degree of the lesion established by imaging studies or arthroscopy and to the chronicity of the lesion. Both together essentially determine the healing potential and the prognosis, which rapidly decrease after six weeks from the initial trauma, thus indicating the importance of recognizing the acute or subacute lesion and directing the patient to the hand surgeon early enough. The therapeutic options are notably reduced and often of palliative nature in case of chronic lesions with secondary changes in the wrist mechanics or cartilage damage.