Treatment of dynamic scapholunate instability dissociation: Contribution of arthroscopy

Scapholunate (SL) ligament injuries generally result from trauma to an extended, supinated wrist, leading to chronic instability that progresses toward osteoarthritis. They can occur together with distal radius fracture. These injuries can be difficult to diagnose, especially early on. Treating chronic SL ligament injuries before the onset of osteoarthritis is still a challenge for surgeons. Until recently, the recommended treatments consisted of open SL ligament reconstruction or repair procedures that reduce pain and improve pinch strength but also lead to wrist stiffness. The introduction of arthroscopy has completely changed our understanding of these injuries and how to treat them. We review here the treatment approach through the eyes of three specific groups of surgeons: the "pioneers" who first analyzed these injuries; the "specialists" who explored various stabilization techniques to compensate for the torn SL ligament; and the most recent group, the "anatomists" who, based on recent arthroscopy findings, sought to reconstruct the anatomical structures as accurately as possible and who developed the concept of the SL complex.