Arthroscopic Dorsal Ligamentocapsulodesis in the Management of Combined Tears of Scapholunate and Lunotriquetral Ligaments: Surgical Technique and Preliminary Clinical Results

Özçelık, İsmail Bülent; Ayık, Ömer; Demіrel, Mehmet; Yıldırım, Tuğrul; Uğurlar, Meriç

doi:10.1055/s-0042-1751078

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…If scapholunate or LT injury caused carpal instability, dorsal ligamentocapsulodesis is performed. 19,20 The dorsal ligamentocapsulodesis was described by Mathoulin et al 21 to reduce back and repair the dorsal capsular detachment together with the LT ligament tear. The sutures are passed through the dorsal capsule and remnants of the intrinsic ligament through the 3 to 4 radiocarpal portal, then retrieved in the midcarpal joint, externalized, tied to themselves at the radial midcarpal portals and reinserted.…”

Section: Exposure and Reconstructionmentioning

confidence: 99%

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Reverse Wafer Procedure for Ulnar Impaction Syndrome

Ozcelik,

Jusoh,

Cavit

2023

Techniques in Hand &Amp; Upper Extremity Surgery

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Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the “reverse wafer procedure” for ulnar impaction syndrome. In this surgical technique, we resected the proximal ulnar side of the lunate instead of partial resection of the thin wafer of the distal ulnar head dome in the standard wafer procedure. This technique avoids iatrogenic central tear of triangular fibrocartilage and distal radioulnar joint portal arthroscopy, which is technically demanding while preserving the distal radioulnar joint.

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Section: Exposure and Reconstructionmentioning

confidence: 99%

“…Midcarpal examination was also performed over the ulnar midcarpal viewing portal to look for the integrity of the scapholunate and LT ligaments. If scapholunate or LT injury caused carpal instability, dorsal ligamentocapsulodesis is performed 19,20 …”

Section: Indications/contraindicationsmentioning

confidence: 99%

Reverse Wafer Procedure for Ulnar Impaction Syndrome

Ozcelik,

Jusoh,

Cavit

2023

Techniques in Hand &Amp; Upper Extremity Surgery

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“…Da das SL-Band sehr kurze Fasern hat, ist eine verzögerte Versorgung aufgrund der üblichen Schrumpfungstendenz von rupturierten Sehnen/Bändern problematisch [1]. Die frühzeitige Diagnose eine (intraligamentär) bis 3 Wochen (dorsal oder palmar) nach dem Trauma kann durch Fixierung von Scaphoid und Lunatum in anatomischer Stellung zur direkten Heilung führen.…”

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“…Die operative SL-Bandrekonstruktion kann durch Fixation der vorhandenen Bandstümpfe kombiniert mit einer Umlagerung eines karpalen Bandes (Ligamentum intercarpale dorsale), sogenannte dorsale Kapsulodese oder Bandersatzplastiken mit autologen Sehnenstreifen, die durch Bohrlöcher durch die Karpale hindurchgefädelt werden, erfolgen. Dabei ist die Rekonstruktion bei einer älteren statischen DISI-Formation (DISI = Dorsal Intercalated Segment Instability) zunehmend in Frage gestellt worden, da die postoperativen Ergebnisse sich nicht immer als befriedigend erweisen [1,4].…”

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Therapie der SL-Bandruptur, SLAC-Wrist und Folgeoperationen

Seyhan¹

2023

Praxis Handreha

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Comparing Open and Arthroscopic Grafting for Scaphoid Nonunion: Is There Truly a Noticeable Difference?

Eravsar,

Özdemir,

Acar

2024

Clin Orthop Relat Res

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Background Scaphoid nonunion remains a challenging injury with no clear consensus on treatment. Surgical options, such as bone grafting procedures, are available for the treatment of scaphoid nonunions. While open grafting provides direct visualization, it is theoretically believed to lead to several problems due to the complex ligamentous structure responsible for wrist stability and challenges in the vascular supply of the scaphoid. On the other hand, despite its technical challenges, arthroscopic grafting is thought to avoid complications by preserving surrounding tissues. Questions/purposes (1) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion report better function than patients undergoing an open procedure? (2) Do patients undergoing bone grafting via arthroscopy for scaphoid nonunion demonstrate better objective outcomes, such as ROM, extremity strength, and bony union? Methods Between January 2012 and January 2022, we operated on 141 patients with scaphoid nonunion. The following patients were excluded from this study: 33 patients with scaphoid nonunion advanced collapse and arthritis, 18 patients with proximal pole fractures, 5 patients with previous surgeries, 16 patients with avascular necrosis, and 8 patients with the radius used as a graft source. In total, 28 patients underwent open grafting, and 33 patients underwent arthroscopic grafting; for both groups, the iliac crest was used as the graft source. Two patients with nonunion were observed in each treatment group, and they were excluded from the study. Results from the remaining 26 patients treated with open grafting and 31 patients treated with arthroscopic grafting (totaling 57 patients) were analyzed. The decision to treat patients with open or arthroscopic methods was not based on a particular reason. In our clinic, we initially preferred open grafting for treating nonunion of the scaphoid. Subsequently, we began to prefer arthroscopic methods for the treatment of these injuries. Twenty patients in the arthroscopic group had additional ligamentous injuries, which were simultaneously treated arthroscopically. All patients in both groups had at least 1 year of follow-up, but 48% of patients treated arthroscopically and 42% of those treated with open approaches were lost before 2 years of follow-up. The remaining patients had follow-up periods longer than 24 months. Our primary analysis was performed at 1 year, and we did a secondary analysis at 2 years. We compared the Patient-Rated Wrist Evaluation (PRWE), QuickDASH, and VAS scores of the patients. We also compared ROM and grip and pinch strength in patients’ contralateral wrists. We used predefined, evidence-based thresholds for the minimum clinically important differences for these outcome measures. Results According to the 1-year functional analysis, we found no clinically important difference between the open surgery group and the arthroscopic surgery group in terms of PRWE score (median [IQR] 19 [25] versus 8 [9], difference of medians 11; p = 0.001), QuickDASH (median 14 [23] versus 7 [11], difference of medians 7; p = 0.004), and VAS scores (median 2 [2] versus 1 [1], difference of medians 1; p = 0.02). At 1 year, there were no differences in objective measurements, including grip strength (median 81 [16] versus 85 [14], difference of medians 4; p = 0.60), pinch strength (median 82 [18] versus 81 [15], difference of medians 1; p = 0.85), and ROM (flexion-extension median 83 [22] versus 85 [13], difference of medians 2; p = 0.74; radial deviation-ulnar deviation median 80 [36] versus 85 [14], difference of medians 5; p = 0.61). In the 2-year analysis, no clinically important difference was observed in terms of PRWE score, and no differences were found in terms of QuickDASH, VAS, strength tests, and ROM between the open and arthroscopic groups. No difference was observed in the union rates between the open group and the arthroscopic group (93% [26 of 28] versus 94% [31 of 33], OR 1.19 [95% CI 0.16 to 9.06]; p = 0.86). Conclusion In comparing open surgical procedures with arthroscopic techniques for the treatment of scaphoid nonunions, the present study revealed no differences in functional outcomes and objective measures such as ROM and strength tests at both the 1-year and 2-year follow-up visits. Although technically more challenging, arthroscopy provides a potential advantage, such as addressing concomitant ligament injuries simultaneously. However, patients did not perceive a difference between the two surgical methods. In future studies, investigating long-term outcomes in a larger population will contribute to better elucidating this issue. Level of Evidence Level III, therapeutic study.

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Arthroscopic Dorsal Ligamentocapsulodesis in the Management of Combined Tears of Scapholunate and Lunotriquetral Ligaments: Surgical Technique and Preliminary Clinical Results

Cited by 3 publications

References 13 publications

Reverse Wafer Procedure for Ulnar Impaction Syndrome

Reverse Wafer Procedure for Ulnar Impaction Syndrome

Therapie der SL-Bandruptur, SLAC-Wrist und Folgeoperationen

Comparing Open and Arthroscopic Grafting for Scaphoid Nonunion: Is There Truly a Noticeable Difference?

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