Download PDF
J Wrist Surg 2021; 10(03): 234-240
DOI: 10.1055/s-0040-1722571
Scientific Article

Four-Dimensional CT Analysis of Dorsal Intercalated Segment Instability in patients with Suspected Scapholunate Instability

Lionel Athlani
1   Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
3   IADI Laboratory, INSERM U1254, Université de Lorraine, Nancy, France
,
Jonathan Granero
1   Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
,
Kamel Rouizi
2   Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
,
Gabriela Hossu
3   IADI Laboratory, INSERM U1254, Université de Lorraine, Nancy, France
,
Alain Blum
2   Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
3   IADI Laboratory, INSERM U1254, Université de Lorraine, Nancy, France
,
Gilles Dautel
1   Department of Hand Surgery, Plastic and Reconstructive Surgery, Centre Chirurgical Emile Gallé, Nancy University Hospital, Nancy, France
,
Pedro Augusto Gondim Teixeira
2   Guilloz Imaging Department, Central Hospital, Nancy University Hospital, Nancy, France
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Background In this study we sought to evaluate the contribution of dynamic four-dimensional computed tomography (4DCT) relative to the standard imaging work-up for the identification of the dorsal intercalated segment instability (DISI) in patients with suspected chronic scapholunate instability (SLI).

Methods Forty patients (22 men, 18 women; mean age 46.5 ± 13.1 years) with suspected SLI were evaluated prospectively with radiographs, arthrography, and 4DCT. Based on radiographs and CT arthrography, three groups were defined: positive SLI (n = 16), negative SLI (n = 19), and questionable SLI (n = 5). Two independent readers used 4DCT to evaluate the lunocapitate angle (LCA) (mean, max, coefficient of variation [CV], and range values) during radioulnar deviation.

Results The interobserver variability of the 4DCT variables was deemed excellent (intraclass correlation coefficient = 0.79 to 0.96). Between the three groups, there was no identifiable difference for the LCAmean. The LCAmax values were lower in the positive SLI group (88 degrees) than the negative SLI group (102 degrees). The positive SLI group had significantly lower LCAcv (7% vs. 12%, p = 0.02) and LCArange (18 vs. 27 degrees, p = 0.01) values than the negative SLI group. The difference in all the LCA parameters between the positive SLI group and the questionable SLI group was not statistically significant. When comparing the negative SLI and questionable SLI groups, the LCAcv (p = 0.03) and LCArange (p = 0.02) values were also significantly different. The best differentiation between patients with and without SLI was obtained with a LCAcv and LCArange threshold values of 9% (specificity of 63% and sensitivity of 62%) and 20 degrees (specificity of 71% and sensitivity of 63%), respectively.

Conclusion In this study, 4DCT appeared as a quantitative and reproducible relevant tool for the evaluation of DISI deformity in cases of SLI, including for patients presenting with questionable initial radiography findings.

Level of evidence This is a Level III study.

Keywords

carpal instability - dorsal intercalated segment instability - four-dimensional computed tomography - kinematics - scapholunate ligament

Note

All patients gave their informed consent for this study.


Ethical Approval

This study was approved by our institutional review board and by the local ethics committee (PERSONAL PROTECTION COMMITTEE EST-III, VANDŒUVRE-LES-NANCY, France). This study was registered with the Clinical Trials Registry (no. NCT02401568).




Publication History

Received: 14 September 2020

Accepted: 27 November 2020

Article published online:
22 January 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 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
    Google Scholar
  • 2 Crawford K, Owusu-Sarpong N, Day C, Iorio M. Scapholunate ligament reconstruction: a critical analysis review. JBJS Rev 2016; 4 (04) e41-e48
    CrossrefPubMedGoogle Scholar
  • 3 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 4 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist: diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 2002; 84 (01) 142
    CrossrefPubMedGoogle Scholar
  • 5 Watson H, Ottoni L, Pitts EC, Handal AG. Rotary subluxation of the scaphoid: a spectrum of instability. J Hand Surg [Br] 1993; 18 (01) 62-64
    CrossrefPubMedGoogle Scholar
  • 6 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
    CrossrefPubMedGoogle Scholar
  • 7 Dreant N, Dautel G. Development of a arthroscopic severity score for scapholunate instability [in French]. Chir Main 2003; 22 (02) 90-94
    CrossrefPubMedGoogle Scholar
  • 8 Geissler WB. Arthroscopic management of scapholunate instability [in French]. Chir Main 2006; 25 (Suppl. 01) S187-S196
    CrossrefPubMedGoogle Scholar
  • 9 Taleisnik J. Current concepts review. Carpal instability. J Bone Joint Surg Am 1988; 70 (08) 1262-1268
    CrossrefPubMedGoogle Scholar
  • 10 Larsen CF, Amadio PC, Gilula LA, Hodge JC. Analysis of carpal instability: I. Description of the scheme. J Hand Surg Am 1995; 20 (05) 757-764
    CrossrefPubMedGoogle Scholar
  • 11 Zhao K, Breighner R, Holmes III D, Leng S, McCollough C, An KN. A technique for quantifying wrist motion using four-dimensional computed tomography: approach and validation. J Biomech Eng 2015;137(07):
    Google Scholar
  • 12 Abou Arab W, Rauch A, Chawki MB. et al. Scapholunate instability: improved detection with semi-automated kinematic CT analysis during stress maneuvers. Eur Radiol 2018; 28 (10) 4397-4406
    CrossrefPubMedGoogle Scholar
  • 13 Rauch A, Arab WA, Dap F, Dautel G, Blum A, Gondim Teixeira PA. Four-dimensional CT analysis of wrist kinematics during radioulnar deviation. Radiology 2018; 289 (03) 750-758
    CrossrefPubMedGoogle Scholar
  • 14 Gondim Teixeira PA, Formery AS, Hossu G. et al. Evidence-based recommendations for musculoskeletal kinematic 4D-CT studies using wide area-detector scanners: a phantom study with cadaveric correlation. Eur Radiol 2017; 27 (02) 437-446
    CrossrefPubMedGoogle Scholar
  • 15 Omori S, Moritomo H, Omokawa S, Murase T, Sugamoto K, Yoshikawa H. In vivo 3-dimensional analysis of dorsal intercalated segment instability deformity secondary to scapholunate dissociation: a preliminary report. J Hand Surg Am 2013; 38 (07) 1346-1355
    CrossrefPubMedGoogle Scholar
  • 16 Laulan J. Rotatory subluxation of the scaphoid: pathology and surgical management [in French]. Chir Main 2009; 28 (04) 192-206
    CrossrefPubMedGoogle Scholar
  • 17 Koh KH, Lee HI, Lim KS, Seo JS, Park MJ. Effect of wrist position on the measurement of carpal indices on the lateral radiograph. J Hand Surg Eur Vol 2013; 38 (05) 530-541
    CrossrefPubMedGoogle Scholar
  • 18 Pérez AJ, Jethanandani RG, Vutescu ES, Meyers KN, Lee SK, Wolfe SW. Role of ligament stabilizers of the proximal carpal row in preventing dorsal intercalated segment instability: a cadaveric study. J Bone Joint Surg Am 2019; 101 (15) 1388-1396
    CrossrefPubMedGoogle Scholar
  • 19 Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am 2004; 29 (02) 279-288
    CrossrefPubMedGoogle Scholar
  • 20 Mathoulin CL. Indications, techniques, and outcomes of arthroscopic repair of scapholunate ligament and triangular fibrocartilage complex. J Hand Surg Eur Vol 2017; 42 (06) 551-566
    CrossrefPubMedGoogle Scholar
  • 21 Degeorge B, Coulomb R, Kouyoumdjian P, Mares O. Arthroscopic dorsal capsuloplasty in scapholunate tears EWAS 3: preliminary results after a minimum follow-up of 1 year. J Wrist Surg 2018; 7 (04) 324-330
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Bille B, Harley B, Cohen H. A comparison of CT arthrography of the wrist to findings during wrist arthroscopy. J Hand Surg Am 2007; 32 (06) 834-841
    CrossrefPubMedGoogle Scholar
  • 24 Lee YH, Choi YR, Kim S, Song HT, Suh JS. Intrinsic ligament and triangular fibrocartilage complex (TFCC) tears of the wrist: comparison of isovolumetric 3D-THRIVE sequence MR arthrography and conventional MR image at 3 T. Magn Reson Imaging 2013; 31 (02) 221-226
    CrossrefPubMedGoogle Scholar
  • 25 Obdeijn MC, Tuijthof GJ, van der Horst CM, Mathoulin C, Liverneaux P. Trends in wrist arthroscopy. J Wrist Surg 2013; 2 (03) 239-246
    Article in Thieme ConnectPubMedGoogle Scholar