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J Wrist Surg 2021; 10(06): 484-491
DOI: 10.1055/s-0041-1728802
Special Review: The Scapholunate Dilemma

Design Requirements for Scapholunate Interosseous Ligament Reconstruction

Frederick W. Werner 
1   Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, New York
› Author Affiliations Funding The study was supported by Department of Orthopedic Surgery, State University of New York, Upstate Medical University.
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Abstract

Background As numerous repairs, reconstructions, and replacements have been used following scapholunate interosseous ligament (SLIL) injury, there is a need to define the structural requirements for any reconstruction or replacement.

Methods Research has been conducted on the force needed to keep the scaphoid and lunate reduced following simulated injury, the failure force of the native SLIL and various replacements, the stiffness of the SLIL and replacements, and the torsional resistance of the scaphoid relative to the lunate.

Results Forces on the order of 50 N are needed to keep the scaphoid and lunate reduced during simple wrist motions in the chronically injured wrist. Even greater forces (up to 110 N) are needed to keep the bones reduced during strenuous activities, such as pushups. The failure force of the entire SLIL has been reported to be as high as 350 N and the failure force of just the dorsal component of the SLIL to be 270 N.

Conclusions The design requirements for a reconstruction or repair may vary depending upon the demands of the patient. In a high demand patient, a reconstruction needs to support the above-mentioned forces during cyclic loading (50 N), when performing strenuous activities (110 N), or during a fall (at least 350 N). Any artificial replacement must undergo careful biocompatibility testing.

Keywords

scapholunate interosseous ligament - design requirements


Publication History

Received: 21 August 2020

Accepted: 04 March 2021

Article published online:
01 May 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Harvey EJ, Berger RA, Osterman AL, Fernandez DL, Weiss AP. Bone-tissue-bone repairs for scapholunate dissociation. J Hand Surg Am 2007; 32 (02) 256-264
    CrossrefPubMedGoogle Scholar
  • 2 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (06) 991-1002
    CrossrefPubMedGoogle Scholar
  • 3 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part II. J Hand Surg Am 2005; 30 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 4 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: Part III. J Hand Surg Am 2007; 32 (03) 297-309
    CrossrefPubMedGoogle Scholar
  • 5 Werner FW, Sutton LG, Allison MA, Gilula LA, Short WH, Wollstein R. Scaphoid and lunate translation in the intact wrist and following ligament resection: a cadaver study. J Hand Surg Am 2011; 36 (02) 291-298
    CrossrefPubMedGoogle Scholar
  • 6 Dimitris C, Werner FW, Joyce DA, Harley BJ. Force in the scapholunate interosseous ligament during active wrist motion. J Hand Surg Am 2015; 40 (08) 1525-1533
    CrossrefPubMedGoogle Scholar
  • 7 Scordino L, Werner FW, Harley BJ. Force in the scapholunate interosseous ligament during 2 simulated pushup positions. J Hand Surg Am 2016; 41 (05) 624-629
    CrossrefPubMedGoogle Scholar
  • 8 Yi R, Werner FW, Sikerwar S, Harley BJ. Force required to maintain reduction of a preexisting scapholunate dissociation. J Hand Surg Am 2018; 43 (09) 812-818
    CrossrefPubMedGoogle Scholar
  • 9 Johnston JD, Small CF, Bouxsein ML, Pichora DR. Mechanical properties of the scapholunate ligament correlate with bone mineral density measurements of the hand. J Orthop Res 2004; 22 (04) 867-871
    CrossrefPubMedGoogle Scholar
  • 10 Waters MS, Werner FW, Haddad SF, McGrattan ML, Short WH. Biomechanical evaluation of scaphoid and lunate kinematics following selective sectioning of portions of the scapholunate interosseous ligament. J Hand Surg Am 2016; 41 (02) 208-213
    CrossrefPubMedGoogle Scholar
  • 11 Bickert B, Sauerbier M, Germann G. Scapholunate ligament repair using the Mitek bone anchor. J Hand Surg [Br] 2000; 25 (02) 188-192
    CrossrefPubMedGoogle Scholar
  • 12 Lavernia CJ, Cohen MS, Taleisnik J. Treatment of scapholunate dissociation by ligamentous repair and capsulodesis. J Hand Surg Am 1992; 17 (02) 354-359
    CrossrefPubMedGoogle Scholar
  • 13 Pomerance J. Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma. J Hand Surg Am 2006; 31 (08) 1380-1386
    CrossrefPubMedGoogle Scholar
  • 14 Bleuler P, Shafighi M, Donati OF, Gurunluoglu R, Constantinescu MA. Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis longus tenodesis. J Hand Surg Am 2008; 33 (02) 281-284
    CrossrefPubMedGoogle Scholar
  • 15 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
    CrossrefPubMedGoogle Scholar
  • 16 Herbert TJ. Acute rotary dislocation of the scaphoid: a new technique of repair using Herbert screw fixation across the scapho-lunate joint. World J Surg 1991; 15 (04) 463-469
    CrossrefPubMedGoogle Scholar
  • 17 Peterson SL, Freeland AE. Scapholunate stabilization with dynamic extensor carpi radialis longus tendon transfer. J Hand Surg Am 2010; 35 (12) 2093-2100
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Talwalkar SC, Edwards AT, Hayton MJ, Stilwell JH, Trail IA, Stanley JK. Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability. J Hand Surg [Br] 2006; 31 (01) 110-117
    CrossrefPubMedGoogle Scholar
  • 20 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
    CrossrefPubMedGoogle Scholar
  • 21 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (02) 205-215
    CrossrefPubMedGoogle Scholar
  • 22 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
    CrossrefPubMedGoogle Scholar
  • 23 Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 1999; 24 (05) 953-962
    CrossrefPubMedGoogle Scholar
  • 24 Sokolow C, Saffar P. Anatomy and histology of the scapholunate ligament. Hand Clin 2001; 17 (01) 77-81
    CrossrefPubMedGoogle Scholar
  • 25 Nikolopoulos FV, Apergis EP, Poulilios AD, Papagelopoulos PJ, Zoubos AV, Kefalas VA. Biomechanical properties of the scapholunate ligament and the importance of its portions in the capitate intrusion injury. Clin Biomech (Bristol, Avon) 2011; 26 (08) 819-823
    CrossrefPubMedGoogle Scholar
  • 26 Logan SE, Nowak MD, Gould PL, Weeks PM. Biomechanical behavior of the scapholunate ligament. Biomed Sci Instrum 1986; 22: 81-85
    PubMedGoogle Scholar
  • 27 Pang EQ, Douglass N, Behn A, Winterton M, Rainbow MJ, Kamal RN. Tensile and torsional structural properties of the native scapholunate ligament. J Hand Surg Am 2018; 43 (09) 864.e1-864.e7
    CrossrefPubMedGoogle Scholar
  • 28 Harvey EJ, Hanel D, Knight JB, Tencer AF. Autograft replacements for the scapholunate ligament: a biomechanical comparison of hand-based autografts. J Hand Surg Am 1999; 24 (05) 963-967
    CrossrefPubMedGoogle Scholar
  • 29 Rajan PV, Day CS. Scapholunate interosseous ligament anatomy and biomechanics. J Hand Surg Am 2015; 40 (08) 1692-1702
    CrossrefPubMedGoogle Scholar
  • 30 Werner FW, Taormina JL, Sutton LG, Harley BJ. Structural properties of 6 forearm ligaments. J Hand Surg Am 2011; 36 (12) 1981-1987
    CrossrefPubMedGoogle Scholar
  • 31 Cuénod P, Charrière E, Papaloïzos MY. A mechanical comparison of bone-ligament-bone autografts from the wrist for replacement of the scapholunate ligament. J Hand Surg Am 2002; 27 (06) 985-990
    CrossrefPubMedGoogle Scholar
  • 32 Hofstede DJ, Ritt MJ, Bos KE. Tarsal autografts for reconstruction of the scapholunate interosseous ligament: a biomechanical study. J Hand Surg Am 1999; 24 (05) 968-976
    CrossrefPubMedGoogle Scholar
  • 33 Svoboda SJ, Eglseder Jr WA, Belkoff SM. Autografts from the foot for reconstruction of the scapholunate interosseous ligament. J Hand Surg Am 1995; 20 (06) 980-985
    CrossrefPubMedGoogle Scholar
  • 34 Pang EQ, Douglass N, Behn A, Winterton M, Rainbow MJ, Kamal RN. The relationship between the tensile and the torsional properties of the native scapholunate ligament and carpal kinematics. J Hand Surg Am 2020; 45 (05) 456.e1-456.e7
    CrossrefPubMedGoogle Scholar
  • 35 American Society for Testing and Materials. ASTM F1983 Standard Practice for Assessment of Selected Tissue Effects on Absorbable Biomaterials for Implant Applications. West Conshohocken, PA: American Society for Testing and Materials; 2014
    Google Scholar