Arthroscopic scapholunate joint reduction. Is an effective treatment for irreparable scapholunate ligament tears?

Abstract

Background: Irreparable tears to the scapholunate (SL) interosseous ligament area are common causes of mechanical wrist pain and yet treatment of this condition remains challenging. The reduction association of the SL joint (RASL) technique alleviates pain while preserving wrist function by creating a fibrous pseudarthrosis stabilized by a cannulated screw placed through the SL joint. Although arthroscopic RASL (ARASL) is a minimally invasive alternative to the open procedure, its effectiveness in controlling pain and preserving wrist function has not been established.

Questions/purposes: To determinate whether ARASL was obtained relieve pain and restore function to the wrist.

Patients and methods: We reviewed eight patients (nine wrists) who had ARASL for SL instability with a reducible SL ligament tear (chronic lesion) from 2005 to 2009. Seven of eight were males and mean age was 44.5 years (range, 38-56 years). We recorded pain using a scale, the Disabilities of the Arm, Shoulder and Hand (DASH) score, grip strength, and range of motion (ROM). Minimum followup was 12 months (mean, 34.6 months; range, 12-43 months).

Results: The visual analog pain score was rated 5.4 (range, 0-10) preoperatively and 1.5 (1-3) after ARASL. Postoperative grip strength of the wrist was 78% of the contralateral, unaffected wrist. The average postoperative wrist ROM was to 107°, 20% less than the preoperative ROM. The SL angle decreased from 70.5° to 59.3°. In three cases, screws were removed owing to loosening or symptoms.

Conclusions: Our preliminary observations suggest ARASL for treating irreparable SL ligament tear is feasible, controls pain, and improves wrist function while preserving ROM. Larger series with longer followup are required to confirm our observations.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Figures

Fig. 1A–B

(A) AP radiograph of the wrist illustrating scapholunate (SL) diastasis (Terri-Thomas sign) with shortening and pronation of scaphoid distal pole, characteristic of SL ligament tear. (B) Lateral radiograph of the wrist demonstrating dorsal intercalated segment instability deformity with alteration of SL and radiolunate angles.

Fig. 2A–B

Dynamic lateral radiographs of the wrist. The wrist is shown in (A) extension and (B) flexion. These images provide relevant information regarding scapholunate joint reducibility.

Fig. 3

Arthro-MR, coronal view. This view is particularly important for confirmation of scapholunate ligament tear, assessment of cartilage integrity, and identification of additional wrist lesions.

Fig. 4

The figure illustrations the reduction of the scapholunate joint using Kirschner wires as joysticks.

Fig. 5A–B

(A) Reduction association of the scapholunate joint. Note the optimal placement of the screw at the ulnar angle of the lunate. (B) Lateral view depicting optimal positioning of the screw at the central axis of the joint.

Fig. 6

Lateral radiograph of the wrist. Immediate postoperative image shows reduction in scapholunate and radiolunate angles.

Fig. 7

Additional stability may be added by a scaphocapitate Kirchner wire.