Cadaveric Testing of a Novel Scapholunate Ligament Reconstruction
12 December 2016
12 September 2017
26 October 2017 (eFirst)
Background Existing scapholunate interosseous ligament (SLIL) reconstruction techniques include fixation spanning the radiocarpal joint, which do not reduce the volar aspect of the scapholunate interval and may limit wrist motion.
Questions/Purpose This study tested the ability of an SLIL reconstruction technique that approximates both the volar and dorsal scapholunate intervals, without spanning the radiocarpal joint, to restore static scapholunate relationships.
Methods Scapholunate interval, scapholunate angle, and radiolunate angle were measured in nine human cadaveric specimens with the SLIL intact, sectioned, and reconstructed. Fluoroscopic images were obtained in six wrist positions. The reconstruction was performed by passing tendon graft through bone tunnels from the dorsal surface toward the volar corner of the interosseous surface. After reduction of the scapholunate articulation, the graft was tensioned within the lunate bone tunnel, secured with an interference screw in the scaphoid, and sutured to the dorsal SLIL remnant. Differences among testing states were evaluated using repeated measures ANOVA.
Results There was a significant increase in the scapholunate interval in all wrist positions after complete SLIL disruption. Compared with the disrupted state, there was a significant decrease in scapholunate interval in all wrist positions after reconstruction using a tendon graft and interference screw.
Conclusion Our SLIL reconstruction technique reconstructs the volar and dorsal ligaments of the scapholunate joint and adequately restores static measures of scapholunate stability. This technique does not tether the radiocarpal joint and aims to optimize volar reduction.
Clinical Relevance Our technique offers an alternative option for SLIL reconstruction that successfully restores static scapholunate relationships.
Institutional ethical board review approval was obtained from the IRB of the Hospital for Special Surgery. The work was performed at the Hospital for Special Surgery.
- 1 Peterson SL, Freeland AE. Scapholunate stabilization with dynamic extensor carpi radialis longus tendon transfer. J Hand Surg Am 2010; 35 (12) 2093-2100
- 2 Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin 1987; 3 (01) 81-102
- 3 Bloom HT, Freeland AE, Bowen V, Mrkonjic L. The treatment of chronic scapholunate dissociation: an evidence-based assessment of the literature. Orthopedics 2003; 26 (02) 195-203 , quiz 204–205
- 4 Gajendran VK, Peterson B, Slater Jr RR, Szabo RM. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation. J Hand Surg Am 2007; 32 (09) 1323-1333
- 5 Moran SL, Cooney WP, Berger RA, Strickland J. Capsulodesis for the treatment of chronic scapholunate instability. J Hand Surg Am 2005; 30 (01) 16-23
- 6 Szabo RM. Scapholunate ligament repair with capsulodesis reinforcement. J Hand Surg Am 2008; 33 (09) 1645-1654
- 7 Almquist EE, Bach AW, Sack JT, Fuhs SE, Newman DM. Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation. J Hand Surg Am 1991; 16 (02) 322-327
- 8 Rosenwasser MP, Miyasajsa KC, Strauch RJ. The RASL procedure: reduction and association of the scaphoid and lunate using the Herbert screw. Tech Hand Up Extrem Surg 1997; 1 (04) 263-272
- 9 Lee SK, Zlotolow DA, Sapienza A, Karia R, Yao J. Biomechanical comparison of 3 methods of scapholunate ligament reconstruction. J Hand Surg Am 2014; 39 (04) 643-650
- 10 Brunelli GA, Brunelli GR. A new surgical technique for carpal instability with scapholunate dissociation. Surg Technol Int 1996; 5: 370-374
- 11 Van Den Abbeele KL, Loh YC, Stanley JK, Trail IA. Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg Br 1998; 23 (02) 258-261
- 12 Links AC, Chin SH, Waitayawinyu T, Trumble TE. Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg Am 2008; 33 (06) 850-856
- 13 Chabas JF, Gay A, Valenti D, Guinard D, Legre R. Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients. J Hand Surg Am 2008; 33 (09) 1469-1477
- 14 De Smet L, Van Hoonacker P. Treatment of chronic static scapholunate dissociation with the modified Brunelli technique: preliminary results. Acta Orthop Belg 2007; 73 (02) 188-191
- 15 Talwalkar SC, Edwards AT, Hayton MJ, Stilwell JH, Trail IA, Stanley JK. Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability. J Hand Surg Br 2006; 31 (01) 110-117
- 16 Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 1999; 24 (05) 953-962
- 17 Nikolopoulos FV, Apergis EP, Poulilios AD, Papagelopoulos PJ, Zoubos AV, Kefalas VA. Biomechanical properties of the scapholunate ligament and the importance of its portions in the capitate intrusion injury. Clin Biomech (Bristol, Avon) 2011; 26 (08) 819-823
- 18 Lee SK, Park J, Baskies M, Forman R, Yildirim G, Walker P. Differential strain of the axially loaded scapholunate interosseus ligament. J Hand Surg Am 2010; 35 (02) 245-251
- 19 Dunn MJ, Johnson C. Static scapholunate dissociation: a new reconstruction technique using a volar and dorsal approach in a cadaver model. J Hand Surg Am 2001; 26 (04) 749-754
- 20 Marcuzzi A, Leti Acciaro A, Caserta G, Landi A. Ligamentous reconstruction of scapholunate dislocation through a double dorsal and palmar approach. J Hand Surg [Br] 2006; 31 (04) 445-449
- 21 del Piñal F, Studer A, Thams C, Glasberg A. An all-inside technique for arthroscopic suturing of the volar scapholunate ligament. J Hand Surg Am 2011; 36 (12) 2044-2046
- 22 Henry M. Reconstruction of both volar and dorsal limbs of the scapholunate interosseous ligament. J Hand Surg Am 2013; 38 (08) 1625-1634
- 23 Ho PC, Wong CW, Tse WL. Arthroscopic-assisted combined dorsal and volar scapholunate ligament reconstruction with tendon graft for chronic SL instability. J Wrist Surg 2015; 4 (04) 252-263
- 24 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (01) 125-134
- 25 Pollock PJ, Sieg RN, Baechler MF, Scher D, Zimmerman NB, Dubin NH. Radiographic evaluation of the modified Brunelli technique versus the Blatt capsulodesis for scapholunate dissociation in a cadaver model. J Hand Surg Am 2010; 35 (10) 1589-1598
- 26 Ellanti P, Sisodia G, Al-Ajami A, Ellanti P, Harrington P. The modified Brunelli procedure for scapholunate instability: a single centre study. Hand Surg 2014; 19 (01) 39-42
- 27 Elgammal A, Lukas B. Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients. J Hand Surg Eur Vol 2016; 41 (01) 56-63
- 28 Nienstedt F. Treatment of static scapholunate instability with modified Brunelli tenodesis: results over 10 years. J Hand Surg Am 2013; 38 (05) 887-892
- 29 Sousa M, Aido R, Freitas D, Trigueiros M, Lemos R, Silva C. Scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. J Hand Surg Am 2014; 39 (08) 1512-1516
- 30 Eng K, Wagels M, Tham SK. Cadaveric scapholunate reconstruction using the ligament augmentation and reconstruction system. J Wrist Surg 2014; 3 (03) 192-197
- 31 Carlson MG, Warner KK, Meyers KN, Hearns KA, Kok PL. Mechanics of an anatomical reconstruction for the thumb metacarpophalangeal collateral ligaments. J Hand Surg Am 2013; 38 (01) 117-123
- 32 Dy CJ, Tucker SM, Hearns KA, Carlson MG. Comparison of in vitro motion and stability between techniques for index metacarpophalangeal joint radial collateral ligament reconstruction. J Hand Surg Am 2013; 38 (07) 1324-1330
- 33 Salva-Coll G, Garcia-Elias M, Hagert E. Scapholunate instability: proprioception and neuromuscular control. J Wrist Surg 2013; 2 (02) 136-140
- 34 Harvey EJ, Hanel DP. Bone-ligament-bone reconstruction for scapholunate disruption. Tech Hand Up Extrem Surg 2002; 6 (01) 2-5
- 35 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (02) 205-215
- 36 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (08) 1612-1632
- 37 Palmer AK, Dobyns JH, Linscheid RL. Management of post-traumatic instability of the wrist secondary to ligament rupture. J Hand Surg Am 1978; 3 (06) 507-532