Arthroscopic Repair of the Dorsal Intercarpal Ligament Detachment from the Scaphoid

Abstract

Background The dorsal intercarpal ligament, whose role in dorsal stability of the wrist has been shown, can be harmed in case of injury to the dorsal scapholunate complex. However, dorsal intercarpal ligament injury also seems to exist isolated posttraumatic forms of dorsal intercarpal ligament rupture, much rarer, through bony avulsion on its scaphoid insertion. The authors report the first description of this lesion, and propose a technique for arthroscopic repair. Description of Technique Radiocarpal arthroscopy will confirm the bony avulsion of the dorsal intercarpal ligament from the scaphoid. Under arthroscopic control, an anchor can be placed into the dorsal aspect of the scaphoid and the ligament can be reattached along with the dorsal capsule. Patients and Methods Between 2018 and 2020, seven patients underwent arthroscopic repair of this particular injury. They presented a painful preoperative wrist with decreased range of motion, and were treated arthroscopically, with anchored reinsertion of the ligament on the scaphoid. Results After a mean follow-up period of 12 months, arthroscopic repair showed decreased pain (6.7 to 0.2), improved range of motion in flexion (66 to 82 degrees) and extension (57 to 87 degrees°), and improved Disabilities of the Arm, Shoulder, and Hand (DASH) score (68.45 to 2.23). Conclusions This lesion has so far never been reported in the literature, and seems mechanically different from more common injuries of the scapholunate complex and dorsal capsulo-scapholunate septum with which dorsal intercarpal ligament ruptures are frequently associated. Arthroscopic repair with an anchor is possible without difficulty and seems to give very good results at 1-year follow-up (normal strength and range of motion).

Arthroscopical Reinforcement of an Isolated Insufficiency of the Radioscaphocapitate Ligament to Treat Dynamic Radioscaphoid Instability: A Case Report

“…7 Merlini and Mathoulin reported an arthroscopical repair of a detachment of the DICL on the scaphoid side. 8 Our arthroscopical reinforcement suture can be performed when persistent radioscaphoid instability is coexisting with the RSCL still present but insufficient due to elongation. The procedure does not require tendon grafts, bone tunnels or anchors and causes potentially less fibrosis and stiffness than open reconstructions.…”

Dorsal Intercarpal Ligament Tears: An Arthroscopic Classification and Clinical Outcomes Study

“…Isolated DICL tears are uncommon, at least in the published literature. 17 It is often associated with intrinsic intercarpal ligament (SLIL and LTIL) and extrinsic ligament injuries (volar radiocarpal or DRCLs) such as those seen in perilunate injuries or midcarpal instability. 28 29 The lack of data on isolated DICL tears is likely due to the lack of knowledge of such pathology, leading to missed diagnosis and delayed presentation.…”

“…We performed the procedure for arthroscopic repair of DICL avulsion as described by Merlini and Mathoulin. 17 After RCJ exploration through the 3–4 portal using a standard wrist arthroscopy setup, the camera is switched to the 6-R portal, leaving the 1–2 and 3–4 portals as the working portals for instrumentation and repair. One can visualize the avulsed DICL from the scaphoid ridge through the 6-R portal ( Fig.…”

“…Short-term results of arthroscopic repair of isolated DICL were reported in a small series of patients with favorable outcomes. 17 This article presents an arthroscopic classification of DICL complex injuries and our clinical outcomes in a series of patients.…”

Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears

“…Since this technique has been described and perfected by Mathoulin, [2][3][4][5][6] we have operated on several hundred patients presenting with an acute or even chronic tear of the scapholunate interosseous ligament (SLIL). Previous published research has shown that at 4-year follow-up, the majority of patients had good to excellent Mayo Wrist Score.…”