Scapholunate Ligament Reconstruction without Immobilization Is Safe and Leads to Better Functional Results

Abstract

Background Reconstruction of the scapholunate ligament (SL) is associated with a reduction in range of motion. In this study, we compared SL reconstruction and early mobilization with SL reconstruction and Kirschner wires (K-wire) fixation for 6 weeks.

Methods We performed a nonrandomized trial involving patients with an arthroscopically confirmed SL ligament injury. In total, 11 patients were assigned to SL reconstruction with internal brace augmentation and early mobilization and 10 were assigned to standard SL reconstruction and K-wire fixation for 6 weeks before mobilization started. We assessed the range of motion, grip strength, functional status, intensity of pain, global perceived effect, and duration until return to work.

Results In both groups, there was one traumatic breakout of the reconstructed ligament and two patients in the control group were lost to follow-up. The 10 patients in the internal brace group had a mean increase in wrist flexion of 1.8 degrees at 1 year compared with a decrease in wrist flexion of 13.4 degrees in the seven patients of the control group. Wrist extension increased by 4.5 degrees in the internal brace group and decreased by 4.5 degrees in the control group. In addition, the internal brace group scored 6.1 (much improved) for the global perceived effect and the control group 4.7 (slightly improved), and treatment without immobilization resulted in an earlier return to work (35.1 vs. 73.6 days).

Conclusions In SL reconstruction, internal brace augmentation and early mobilization result in improved wrist flexion and extension, higher satisfaction, and earlier return to work.

Keywords

immobilization - internal brace - scapholunate ligament

Ethical Approval

Ethical approval for this study was obtained from the Medical Ethics Committee of Martini Hospital, Groningen (2019-111). Written informed consent was obtained from all subjects before the study.

Publication History

Received: 17 January 2022

Accepted: 24 March 2022

Article published online:
06 June 2022

• References

• 1 Crawford K, Owusu-Sarpong N, Day C, Iorio M. Scapholunate ligament reconstruction: a critical analysis review. JBJS Rev 2016; 4 (04) e41-e48
• 2 Andersson JK, Rööser B, Karlsson J. Level of evidence in wrist ligament repair and reconstruction research: a systematic review. J Exp Orthop 2018; 5 (01) 15
• 3 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
• 4 Garcia-Elias M, Lluch AL. Wrist Instabilities, Misalignments, and Dislocations. In: Wolfe S, Hotchkiss R, Pederson W, Kozin S, Cohen M. eds. Green's Operative Hand Surgery, 7th Edition. Philadelphia, PA: Elsevier; 2016. , Chapter 13.
• 5 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (03) 357-365
• 6 Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 1995; 35 (01) 54-59
• 7 Athlani L, Pauchard N, Detammaecker R. et al. Treatment of chronic scapholunate dissociation with tenodesis: a systematic review. Hand Surg Rehabil 2018; 37 (02) 65-76
• 8 Park IJ, Maniglio M, Shin SS, Lim D, McGarry MH, Lee TQ. Internal bracing augmentation for scapholunate interosseous ligament repair: a cadaveric biomechanical study. J Hand Surg Am 2020; 45 (10) 985.e1-985.e9
• 9 Mathoulin C, Merlini L, Taleb C. Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques. J Hand Surg Eur Vol 2021; 46 (01) 5-13