Abstract
Introduction Most surgical techniques for scapholunate interosseous ligament (SLIL) repair address
only the dorsal component of the ligament, potentially leading to high surgical failure
rates. We introduce a new technique to reconstruct the volar SLIL using a portion
of the long radiolunate ligament (LRL). A biomechanical evaluation was performed to
evaluate the rupture strength of this repair, and a subsequent anatomic study was
performed to verify that this repair would not compromise the blood supply to either
the scaphoid or the lunate.
Methods A reconstruction of the volar SLIL was developed utilizing a lunate-based strip of
the LRL. Fourteen cadaver arms were injected with red-colored epoxide and latex. The
blood supply of the volar wrist capsule was dissected. The vascular supply to the
ligaments, scaphoid, and lunate were investigated. The biomechanical strength of this
reconstruction was tested on five cadaver arms by potting the scaphoid, lunate, and
radius and subjecting the repair to a tensile load using a servohydraulic vertical
displacement testing machine.
Results In all arms, a branch of the radial artery or radiocarpal arch supplied the radioscapholunate
ligament at the medial border of the LRL. The proximal half of the scaphoid was supplied
by dorsal branches of the radial artery. In all cases, a vessel entered the lunate
on its ulnar volar side, away from the repair. The average strength of the intact
LRL strip was 97.4 N, and the average strength of the ligament-suture interface used
for the capsulodesis was 43.5 N.
Conclusion This volar approach to the SLIL does not compromise the vascularity of the scaphoid
or the lunate. This approach allows the possibility of repairing or augmenting the
volar SLIL. The strength of this repair appears to be less than the strength of the
native SLIL. Further clinical studies are warranted.
Keywords
scapholunate instability - scapholunate injury - wrist pain - capsuolodesis
