Surgical outcomes of chronic isolated scapholunate interosseous ligament injuries: a systematic review of 805 wrists

Abstract

Background: Management of chronic isolated scapholunate interosseous ligament (SLIL) injuries has generated a substantial volume of low-quality literature with descriptions of multiple new surgical techniques, and the impact of instability pattern and the optimal surgical technique remain unclear. The primary goal of this review was to compare clinical, radiographic and patient-rated outcomes between current surgical techniques.

Methods: We performed a systematic literature search using multiple databases. We analyzed clinical, radiographic and patient-reported outcomes. We used a fixed-effects model weighted by sample size with combined outcomes estimated via least squares means with 95% confidence intervals. We also performed a subgroup analysis of static versus dynamic instability.

Results: We assessed 805 procedures from 37 study groups, with 429 procedures used in subgroup analysis. There were no statistically significant differences in outcomes between surgical techniques or in subgroup analysis. Overall, postoperative wrist flexion and pain scores decreased, and grip strength and patient-rated outcomes improved.

Conclusion: Compared to overall preoperative values, modest improvements in pain score, grip strength and functional outcome scores were obtained from a range of reconstructive procedures performed for chronic isolated SLIL injuries. No significant differences could be ascertained between surgical techniques, potentially owing to the low quality of evidence and procedure heterogeneity. This study provides accurate preoperative reference values for future studies, highlights the controversial clinical impact of instability classification, and the need for higher-quality multicentre or collaborative trials to improve our understanding and management of this common injury.

Conflict of interest statement

None declared.

© 2019 Joule Inc. or its licensors

Figures

Fig. 1

Flow chart showing study selection.

Fig. 2

Scapholunate gap (left) and angle (right) measurements for static and dynamic instability subgroups. Error bars represent 95% confidence intervals.

Fig. 3

Other radiographic and clinical measurements for static and dynamic instability subgroups. A higher value denotes improvement in the Mayo Wrist Score, whereas a lower value denotes improvement in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and Patient-Rated Wrist Evaluation (PRWE) scores. Error bars represent 95% confidence intervals. Pre = preoperative, post = postoperative.