Arthroscopic-Assisted Volar Scapholunate Capsulodesis for EWAS Grade IIIA: A Prospective Case Series Study
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Ahmed Medhat Mohamed1, Ayman Ibrahim Fathy Hewaidy1, Amr Mohamed Aly1
1Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Purpose:
This study evaluated the functional and radiological outcomes of arthroscopically assisted volar scapholunate (SL) capsulodesis for subacute volar SL ligament injury (European Wrist Arthroscopy Society [EWAS] grade IIIA). To the best of our knowledge, isolated subacute (EWAS grade IIIA) injuries has not been specifically studied in the literature, representing a gap in knowledge regarding the management of this rare injury.
Methods:
This prospective case series included patients with isolated subacute (EWAS grade IIIA) injuries who underwent arthroscopically assisted volar capsulodesis using the inside-out technique described by Lui and Kakar. The primary outcomes were functional outcomes assessed using the Disabilities of the Arm, Shoulder, and Hand (DASH) score and Modified Mayo Wrist Score. Secondary outcomes included changes in the SL gap and SL angle, range of motion (ROM), grip strength, and pain assessed using the visual analog scale (VAS).
Results:
The mean follow-up was 27 months. Ten patients (five women and five men) were included. The mean age at surgery was 26 years, Wrist ROM was largely maintained postoperatively. Mean grip strength increased from 65% to 97% of the contralateral side. Mean VAS pain scores decreased from 7.6 to 1.8, mean DASH scores improved from 15 to 3, and mean Modified Mayo Wrist Scores improved from 52.0 to 91.5. Radiographic measures of the SL gap and SL angle were largely maintained postoperatively.
Conclusions:
Arthroscopically assisted volar SL capsulodesis showed substantial improvements in pain, disability, grip strength, and Modified Mayo Wrist Score in patients with EWAS grade IIIA injuries. The proportion of patients achieving clinically meaningful improvement was high for VAS pain and more moderate for DASH. However, the absence of a comparator group, small sample size, and attrition limit causal inference; larger comparative studies with longer follow-up are needed.
Type Of Study/Level Of Evidence:
Prospective case series study, IV.
