Association Between Lunate Morphology and Carpal Collapse in Cases of Scapholunate Dissociation

Rhee, Peter C.; Moran, Steven L.; Shin, Alexander Y.

doi:10.1016/j.jhsa.2009.06.017

Cited by 52 publications

(57 citation statements)

References 38 publications

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“…23 The scaphoid is oblique to the longitudinal axis and tends to rotate into flexion. The lunate is palmarly wedgeshaped in configuration and tends to extend under axial compression load.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months.Paired t-tests were used preoperatively, one month after pin removal, and at final followup to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.

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“…23 The scaphoid is oblique to the longitudinal axis and tends to rotate into flexion. The lunate is palmarly wedgeshaped in configuration and tends to extend under axial compression load.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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“…Arthroscopic assistance of RASL allows for optimal joint alignment [19]. The adjunctive use of arthroscopy conveys relevant information regarding the integrity of the entire wrist, identifying additional unexpected lesions.…”

Section: Discussionmentioning

confidence: 99%

“…The best surgical approach for this challenging lesion is unclear [15,23]. Over the last several decades, an improved understanding of SL joint anatomy and biomechanics [19,21,30] has allowed Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.…”

Section: Introductionmentioning

confidence: 99%

“…for the introduction of several surgical techniques (ie, partial carpal fusions [19,21,24,26,27,30,31], capsulodesis [6,16], tenodesis [7,10,12], bone-tendon-bone reconstructions [13,29], and dynamic tendon transfers [13,29]). Most reflect an aggressive approach and do not lead to an ideal or sustained SL joint alignment [1,[26][27][28][29][30].…”

Section: Introductionmentioning

confidence: 99%

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Arthroscopic Scapholunate Joint Reduction. Is an Effective Treatment for Irreparable Scapholunate Ligament Tears?

Caloia

Pereira

2012

Clinical Orthopaedics &Amp; Related Research

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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 MethodsWe 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.

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“…5B). Rhee and colleagues 16 determined that the bony morphology of the lunate might play a role in preventing the DISI deformity. Preoperative radiographs in a cohort of 58 patients who underwent repair or reconstruction of the SLIL were examined retrospectively.…”

Section: Diagnosismentioning

confidence: 99%

Chronic Scapholunate Ligament Injury

2015

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Association Between Lunate Morphology and Carpal Collapse in Cases of Scapholunate Dissociation

Cited by 52 publications

References 38 publications

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Arthroscopic Scapholunate Joint Reduction. Is an Effective Treatment for Irreparable Scapholunate Ligament Tears?

Chronic Scapholunate Ligament Injury

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