Volar-Dorsal Arthroscopic Repair for Scapholunate Ligament Injuries: A Case Series and Treatment Algorithm

Area of Science:

• Orthopedic surgery
• Arthroscopy
• Wrist biomechanics

Background:

• Scapholunate interosseus ligament (SLIL) disruption presents varied severity, posing diagnostic and treatment challenges.
• Traditional open surgical techniques for SLIL injuries have inconsistent outcomes and risks like postoperative stiffness.
• Mild SLIL instability lacks sufficient minimally invasive management options, making open surgery morbidity difficult to justify.

Purpose of the Study:

• To present an arthroscopic algorithm for treating predynamic SLIL instability without radiographic deformity.
• To demonstrate a case series of dorsal and combined volar-dorsal arthroscopic SLIL repair techniques.
• To evaluate the efficacy of arthroscopic repair for specific grades of SLIL injuries.

Main Methods:

• Retrospective review of eight patients with symptomatic SLIL injuries undergoing arthroscopic repair.
• Application of European Wrist Arthroscopy Society (EWAS) grading for repair technique selection (dorsal or combined volar-dorsal).
• Assessment of pre- and postoperative range of motion, patient-rated outcomes, and radiographic metrics; exclusion of patients with scapholunate diastasis.

Main Results:

• Median patient age was 29.5 years with a mean follow-up of 18.9 months.
• No significant postoperative changes in dorsal intercalated segment instability, alignment, or scapholunate gapping were observed.
• Patients experienced excellent subjective function and range of motion post-arthroscopic repair.

Conclusions:

• A simple, effective suture-based arthroscopic capsuligamentous repair can successfully treat EWAS grade IIIA to C SLIL injuries.
• The technique leads to excellent postoperative motion, function, and pain reduction.
• Arthroscopic repair offers a minimally disruptive option for managing specific SLIL instabilities.