Arthroscopic Reduction-Association of the Scapholunate with an Absorbable Screw
28 November 2016
20 October 2017
08 December 2017 (eFirst)
Background The treatment of chronic scapholunate instability is yet a controversial topic. Arthroscopic reduction-association scapholunate technique is a minimally invasive option in which a stable pseudoarthrosis at the scapholunate joint is obtained, allowing some degree of movement while maintaining the normal alignment of the wrist. The purpose of this study was to review the results of arthroscopic reduction-association scapholunate with an absorbable screw.
Methods We retrospectively evaluated patients with dynamic or static, but reducible, chronic scapholunate instability who underwent arthroscopic reduction-association scapholunate between 2012 and 2015. An absorbable headless compression screw was used in the technique.
Results A total of 33 patients (21 males, 12 females) were included. Average follow-up time was 17 months. At final follow-up, the average postoperative Disabilities of the Arm, Shoulder and Hand (DASH) score was 18 (range, 8–46). The average postoperative grip strength was 30 kg, 73% of the uninjured side. The average extension-palmar flexion arc was 112 degrees, 79% of the uninjured side. The scapholunate angle decreased from 70 degrees preoperatively to 52 degrees postoperatively. In the cases of static lesion, the scapholunate interval decreased from 4.1 mm preoperatively to 2.8 mm at final follow-up. One patient had a breakage of the screw at 4 months, four developed a complex regional pain syndrome, one had a prominence of the screw at the waist of the scaphoid, and four maintained symptoms of instability. From these 10 patients, 5 were submitted to revision surgery.
Conclusion The arthroscopic reduction-association technique is capable of maintaining the reduction of the scapholunate joint and of improving symptoms, while preserving range-of-motion. The use of an absorbable screw is an option in this technique, and may diminish screw-related complications.
Keywordsscapholunate dissociation - carpal instability - reduction-association scapholunate - arthroscopic surgery - absorbable screw
All authors were fully involved in the study and preparation of the manuscript. This material has not been and will not be submitted for publication elsewhere.
- 1 Sokolow C, Saffar P. Anatomy and histology of the scapholunate ligament. Hand Clin 2001; 17 (01) 77-81
- 2 Pappou IP, Basel J, Deal DN. Scapholunate ligament injuries: a review of current concepts. Hand (NY) 2013; 8 (02) 146-156
- 3 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
- 4 Aviles AJ, Lee SK, Hausman MR. Arthroscopic reduction-association of the scapholunate. Arthroscopy 2007; 23 (01) 105.e1-105.e5
- 5 Caloia M, Caloia H, Pereira E. Arthroscopic scapholunate joint reduction. Is an effective treatment for irreparable scapholunate ligament tears?. Clin Orthop Relat Res 2012; 470 (04) 972-978
- 6 Koehler SM, Guerra SM, Kim JM, Sakamoto S, Lovy AJ, Hausman MR. Outcome of arthroscopic reduction association of the scapholunate joint. J Hand Surg Eur Vol 2016; 41 (01) 48-55
- 7 Rajan PV, Day CS. Scapholunate interosseous ligament anatomy and biomechanics. J Hand Surg Am 2015; 40 (08) 1692-1702
- 8 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (02) 205-215
- 9 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
- 10 Lavernia CJ, Cohen MS, Taleisnik J. Treatment of scapholunate dissociation by ligamentous repair and capsulodesis. J Hand Surg Am 1992; 17 (02) 354-359
- 11 Wyrick JD, Youse BD, Kiefhaber TR. Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation. J Hand Surg [Br] 1998; 23 (06) 776-780
- 12 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
- 13 Deshmukh SC, Givissis P, Belloso D, Stanley JK, Trail IA. Blatt's capsulodesis for chronic scapholunate dissociation. J Hand Surg [Br] 1999; 24 (02) 215-220
- 14 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
- 15 Brunelli GA, Brunelli GR. A new technique to correct carpal instability with scaphoid rotary subluxation: a preliminary report. J Hand Surg Am 1995; 20 (3 Pt 2): S82-S85
- 16 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
- 17 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
- 18 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
- 19 Siegel JM, Ruby LK. A critical look at intercarpal arthrodesis: review of the literature. J Hand Surg Am 1996; 21 (04) 717-723
- 20 Hom S, Ruby LK. Attempted scapholunate arthrodesis for chronic scapholunate dissociation. J Hand Surg Am 1991; 16 (02) 334-339
- 21 Filan SL, Herbert TJ. Herbert screw fixation for the treatment of scapholunate ligament rupture. Hand Surg 1998; 3: 47-55
- 22 Cognet JM, Levadoux M, Martinache X. The use of screws in the treatment of scapholunate instability. J Hand Surg Eur Vol 2011; 36 (08) 690-693