Functional and radiological outcomes of the all-dorsal technique for scapholunate ligament reconstruction

Scapholunate instability is a common and challenging wrist pathology with no universally accepted surgical solution. The all-dorsal scapholunate reconstruction technique restores the dorsal ligament with an extensor carpi radialis brevis tendon autograft. The aim of this study was to assess outcomes in patients with a chronic scapholunate ligament rupture.

We retrospectively analysed 31 patients. Outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score and a visual analogue scale score for pain. Clinical examination included wrist range of motion and grip strength. The radiological parameters measured were scapholunate (SL) angle and gap. Follow-up averaged 39 months (range 12-84) for all outcomes.

Postoperatively median pain scores improved from 5 to 2 and disability scores from 58 to 48, although changes were not statistically significant. Median wrist extension at final follow-up measured 50° (IQR 42.5 to 70) and flexion 45° (IQR 39 to 60). Radiographically, there was persistent carpal malalignment with a median SL angle of 66° (IQR 58 to 73), a static SL gap of 3 mm (IQR 2.2 to 4) and a dynamic SL gap of 4.8 mm (IQR 3.3 to 5.4). Median grip strength improved from 28 kg (IQR 20 to 40) preoperatively to 29 kg (20-37) postoperatively. Five patients required salvage procedures owing to progressive symptomatic osteoarthritis. Complications included complex regional pain syndrome (n = 3), transient nerve symptoms (n = 2), anchor-site osteolysis (n = 13) and isolated scaphocapitate joint osteoarthritis (n = 5).

The relative simplicity and preservation of wrist function with the all-dorsal reconstruction technique justify its continued use, despite high complication and revision incidences.

Level IV.