Treatments for Scapholunate Dissociation

Scapholunate (SL) dissociation is the popular carpal instability due to SL ligament injury, showing the scaphoid in flexed position while the lunate and triquetrum in an extended position, resulting in dorsal intercalated segment instability (DISI) deformity. Normally, the posteroanterior radiographs indicate a wide gap between the SL space (more than 4 mm) in SL dissociation and lateral radiographs demonstrate extended lunate. Once DISI deformity occurs, degenerative changes will start from the radial styloid to radioscaphoid and scaphocapitate joints that is known as the SL advanced collapse wrist. Thus, surgical correction of the scaphoid and lunate is considered necessary as early as possible in SL dissociation. There are many treatments for SL dissociation, such as direct repair of the SL ligament, tenodesis procedures for flexed scaphoid, bone–ligament–bone reconstruction, tendon reconstruction of the SL ligament using the palmaris longus tendon or flexor carpi radialis (FCR) tendon in an open fashion or arthroscopically. Still, we do not have right answer to solve SL dissociation.

In this issue, the “Special review” is “Treatment of scapholunate dissociation with FCR-tenodesis: review of MBT and 3LT” by Drs. Goeminne, Stroobants, and van Beek. They organized systematic reviews of literature about modified Brunelli tenodesis (MBT) and three ligament tenodesis (3LT) treatments for SL dissociations and tried to compare MBT and 3LT that would be beneficial to our readers. They concluded that “the MBT and 3LT exhibited comparable reductions in pain and improvements in range of motion, while certain complication rate and secondary osteoarthritis evolution were observed in many cases.” Interesting wrist papers, such as triangular fibrocartilage complex foveal avulsion, computed tomography analysis of scaphoid nonunion fragment, comparison in detecting synovitis on magnetic resonance imaging and wrist arthroscopy, distal radius fracture, dorsal intercarpal ligament injury, suspension arthroplasty, Kienböck disease, interesting case reports, procedure, and systematic review are included in this issue. Do not miss them.

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Artikel online veröffentlicht:
19. Mai 2025