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Related Concept Videos

Ankle Joint01:10

Ankle Joint

1.7K
The ankle is formed by the talocrural joint (crural = leg). It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg. The superior aspect of the talus bone is square-shaped and has three areas of articulation. The top of the talus articulates with the inferior tibia. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations...
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Current Concepts in Scapholunate Instability Without Arthritic Changes.

Melanie Amarasooriya1,2, Terrence Jose Jerome3, Lisa Tourret4

  • 1Department of Orthopedic and Trauma Surgery, Flinders Medical Centre and Flinders University, Bedford Park, South Australia 5042 Australia.

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|April 3, 2023
PubMed
Summary

Scapholunate instability (SLI), a common wrist injury, requires accurate diagnosis and tailored treatment. Current trends favor minimally invasive techniques and biological solutions for better long-term outcomes.

Keywords:
DISIInstabilitySLACScapholunateScapholunate ligamentWrist instability

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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.