Modified Brunelli Reconstruction for Scapholunate Ligament Dissociation

Area of Science:

• Orthopedic Surgery
• Hand and Wrist Surgery
• Reconstructive Surgery

Background:

• Irreparable scapholunate dissociation presents a significant challenge in wrist surgery.
• The modified Brunelli reconstruction, also known as 3-ligament tenodesis, is a specific surgical approach for this condition.
• This technique is indicated when the scapholunate ligament is disrupted beyond repair, but the carpus is free of arthritis.

Purpose of the Study:

• To describe the surgical technique, alternatives, and outcomes of the modified Brunelli reconstruction.
• To detail the indications and methodology for treating irreparable scapholunate dissociation.
• To provide an overview of the functional recovery and pain management associated with this procedure.

Main Methods:

• The modified Brunelli reconstruction involves using a distally based flexor carpi radialis tendon graft.
• The tendon is passed through a transosseous tunnel in the scaphoid and secured to the dorsal wrist capsule.
• This reconstructs the dorsal scapholunate ligament and corrects scaphoid rotation.

Main Results:

• The procedure restores 70%–80% of wrist motion and 65%–75% of grip strength compared to the uninjured wrist.
• Approximately 70%–80% of patients experience good pain relief.
• The technique is reproducible with standard surgical instruments and fluoroscopy.

Conclusions:

• The modified Brunelli reconstruction is an effective treatment for irreparable scapholunate dissociation.
• It offers significant functional recovery and pain reduction.
• The technique is technically straightforward and yields reliable results.