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Published on: January 23, 2018
Long-Term Outcomes of Arthroscope-Assisted Bone-Ligament-Bone Reconstruction for Nonstatic Scapholunate Ligament
Norman Della Rosa1, Nicolò Bertozzi1, Paolo Annoscia1
1From the Department of Hand Surgery and Microsurgery, Azienda Ospedaliero-Universitaria Policlinico of Modena; Plastic Surgery and Reconstructive Unit, "San Martino" Policlinic Hospital-IRCCS for Oncology, Genoa; Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa; and Hand Surgery and Microsurgery Unit, University Hospital of Pisa.
Background:
Scapholunate ligament injury is the most common cause of carpal instability. This retrospective case series aimed to assess the effectiveness and the maintenance of the results obtained by reconstructing the scapholunate ligament with a bone-ligament-bone autograft through an arthroscope-assisted minimally invasive approach.
Methods:
Thirty-six patients were enrolled initially but only 31 constituted the final population study (23 male, eight female; median age, 38 years; age range, 18 to 55 years). Radiographic (posteroanterior and true lateral radiographs to assess the scapholunate gap, radiolunate, and capitolunate angles; computed tomographic scan; magnetic resonance images), functional [grip strength (Jamar test and pinch test), active range of motion], and subjective (patient-rated wrist evaluation test) outcome measurements were collected. Minimum follow-up was 50 months.
Results:
Grip strength and wrist mobility were significantly improved from the preoperative values and improved over time. No scapholunate synostosis or carpal bone necrosis was observed. No wrist showed any sign of arthrosis or progression towards wrist instability. Only four patients had scapholunate gap greater than 3 mm.
Conclusions:
The proposed technique for scapholunate reconstruction, providing a biologic reconstruction of both the volar and dorsal portion of the scapholunate ligament and avoiding extensive capsulotomy, obtained significant functional outcomes improvement that was maintained over time and prevented degenerative changes to the articular surfaces.
Clinical Question/Level Of Evidence:
Therapeutic, IV.