Current Concepts in Scapholunate Instability Without Arthritic Changes

Area of Science:

• Orthopedics
• Hand Surgery
• Biomechanics

Background:

• Scapholunate instability (SLI) is the most frequent carpal instability, often progressing to scapholunate advanced collapse (SLAC) arthritis.
• Diagnosis can be difficult in early stages, with CT arthrogram, MR arthrogram, and dynamic fluoroscopy aiding detection, while arthroscopy is the definitive diagnostic tool.
• SLI involves a complex injury to the dorsal scapholunate ligament (dSLL) complex, including intrinsic and extrinsic carpal ligaments.

Purpose of the Study:

• To review diagnostic challenges and treatment strategies for scapholunate instability.
• To highlight the evolution of surgical techniques and the importance of staging in treatment selection.
• To emphasize the role of minimally invasive approaches and rehabilitation in managing SLI.

Main Methods:

• Review of current literature on scapholunate instability diagnosis and treatment.
• Analysis of various surgical repair and reconstruction techniques, including capsulodesis and tenodesis.
• Discussion of diagnostic modalities such as arthroscopy, CT arthrogram, MR arthrogram, and dynamic fluoroscopy.

Main Results:

• Acute SLI (within 6 weeks) may be amenable to direct repair.
• Chronic SLI without degenerative changes is primarily treated with reconstruction techniques.
• While clinical outcomes have improved, long-term data and radiological progression remain concerns for existing techniques.

Conclusions:

• Accurate staging of SLI is crucial for selecting appropriate reconstruction techniques.
• There is a growing trend towards biological, less invasive surgical options, with arthroscopic approaches offering advantages.
• Preserving nerve supply and implementing a structured rehabilitation program focusing on muscle balance are vital for optimal recovery.