Retinaculum Grafts in Scapholunate Ligament Reconstruction: A Systematic Review

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Sports Medicine

Background:

• Chronic scapholunate (SL) ligament disruption often requires surgical intervention.
• Tendon grafts are commonly used, but retinaculum grafts offer an alternative.
• The bone-retinaculum-bone (BRB) graft is a specific type of retinaculum graft for SL reconstruction.

Purpose of the Study:

• To systematically review the biomechanical and histological properties of the BRB graft.
• To evaluate the clinical outcomes of BRB graft use in SL ligament reconstruction.
• To identify gaps in current research regarding BRB grafts for SL instability.

Main Methods:

• Systematic review of eight studies (five laboratory, three clinical) following abstract screening of 353 articles.
• Analysis of biomechanical data including load to failure and stiffness from cadaveric studies.
• Review of clinical outcomes such as pain relief, grip strength, range of motion, and radiological findings.

Main Results:

• Cadaveric studies indicated BRB grafts have lower load to failure and stiffness compared to the native SL ligament.
• Clinical studies showed BRB grafts provided pain relief and improved grip strength in dynamic SL instability, with a reduced range of motion.
• Radiological assessment revealed no SL widening at 18 months, but a slight increase after 12 years; clinical studies had a level of evidence of 4.

Conclusions:

• Current clinical, histological, and biomechanical data on BRB grafts for SL ligament reconstruction is insufficient.
• Further research is needed to fully understand graft incorporation, remodeling, and long-term outcomes.
• The limited evidence suggests potential benefits but highlights the need for more robust studies.