Scapholunate Ligament Reconstruction with Suture Augmentation: a Biomechanical Analysis.

Area of Science:

• Orthopedic surgery
• Biomechanical engineering
• Anatomy

Background:

• Dorsal intercalated segment instability (DISI) is a common wrist injury.
• Scapholunate interosseous ligament (SLIL) reconstruction aims to restore wrist stability.
• The modified Brunelli technique is a surgical approach for SLIL reconstruction.

Purpose of the Study:

• To compare the biomechanical performance of modified Brunelli SLIL reconstruction with and without suture augmentation.
• To evaluate the effectiveness of these techniques in restoring wrist alignment and stability under cyclic loading.

Main Methods:

• Eight cadaveric wrist pairs underwent SLIL and associated ligament sectioning to induce DISI.
• Reconstruction was performed using the modified Brunelli technique, with one wrist per pair augmented with suture tape.
• Radiographic parameters (SLA, RLA, SLG, DST) were assessed via fluoroscopy at baseline, post-injury, and post-reconstruction.

Main Results:

• Both reconstruction techniques significantly improved wrist alignment compared to the DISI state.
• No significant differences were observed in scapholunate gap, scapholunate angle, or radiolunate angle between graft-only and graft/tape groups.
• The suture tape augmentation group demonstrated a greater reduction in dorsal scaphoid translation compared to the graft-only group.

Conclusions:

• Suture augmentation did not enhance the restoration of scapholunate gap, scapholunate angle, or radiolunate angle.
• Augmentation provided a greater reduction in dorsal scaphoid translation, suggesting potential biomechanical advantages.
• Both modified Brunelli reconstruction techniques are biomechanically effective in restoring and maintaining wrist alignment.