Anatomical Description of the Dorsal Capsulo-Scapholunate Septum (DCSS)—Arthroscopic Staging of Scapholunate Instability after DCSS Sectioning

Abstract

Background The dorsal capsuloligamentous scapholunate septum (DCSS) is a confluence of the dorsal capsule, the dorsal intercarpal ligament (DIC), and the scapholunate interosseous ligament (SLIOL). It appears to play a role in the stability of the scapholunate articulation. The purpose of this study was to describe the anatomical basis for this structure and to investigate its role in scapholunate instability through sectioning of this structure followed by an arthroscopic and fluoroscopic analysis. Material and Methods In the anatomical part of the study we dissected 3 fresh cadaver wrists to examine the anatomy of the DCSS. In the arthroscopic part of the study we assessed the EWAS grade of SL instability before and after sectioning the DCSS and measured the scapholunate and radiolunate angles fluoroscopically. Results Sectioning the DCSS increased the EWAS grade of SL instability but did not affect the scapholunate gap, the scapholunate angle or radiolunate angle. Conclusion We have demonstrated that there is a distinct structure that is separate from the dorsal capsule, which we have labeled the Dorsal Capsuloligamentous Scapholunate Septum. We believe that the DCSS is a previously unreported secondary stabilizer of the SL joint which may have therapeutic and prognostic implications.

Length changes of scapholunate interosseous ligament at different wrist positions: an in vivo 3-dimension image study

“…This discrepancy may result from the biomechanical characteristics of the dorsal and volar subregions themselves. And the existence of the dorsal capsulo-scapholunate septum also can reinforce the dorsal region of the SLIL, resulting in the little change of the length of the dorsal SLIL at different wrist positions [20]. However, it is hard to speculate what our findings implicate for the mechanism determining which regions are more easily disrupted or injured earlier, because both elongated and less extendable ligaments may be injured.…”

Arthroscopic Treatment of Scapholunate Instability

“…Scapholunate joint stability is dependent not only on SLIL but also on a set of primary and secondary stabilizers that collectively form a complex. Among these stabilizers, the dorsal part of the SLIL and the dorsal capsulo-scapholunate septum (DCSS) emerges as the key components of the SL joint stability [8][9][10]. The techniques described here enable the repair of these two structures by a capsule-to-ligament suturing and prevent the stiffness associated with open procedures.…”

Optimal management of scapholunate ligament injuries

“…The DCSS is a ligamentous connection between the dorsal capsule of the wrist to the SLL and the dorsal intercarpal ligament 13. It has been demonstrated in cadaveric studies to play some role in the stability of the scapholunate joint as sectioning of the DCSS results in increased scapholunate instability 14,15…”