Dorsal Capsulodesis and Ligamentoplasty for Chronic Pre-Dynamic and Dynamic Scapholunate Dissociation

Abstract

Scapholunate (SL) instability is the most common cause of carpal instability. Pre-dynamic and dynamic type SL instability is difficult to diagnose and treat. This series reviews 17 soldiers with pre-dynamic or dynamic SL instability diagnosed by midcarpal arthroscopy and treated with dorsal capsulodesis and augmentation ligamentoplasty with partial dorsal radiocarpal (DRC) ligament procedure between 1997 and 2000. The sample included 14 males and three females. The dominant hand was involved in 15 patients. Moreover, the average patient age was 29.3 years (range 19-36 years). The diagnosis was based on clinical and arthroscopic criteria. Fifteen patients were followed up at our clinic regularly, with the follow-up period ranging from 12 to 39 months (mean 25.2 months). Fourteen patients had excellent or good results, and one patient had poor result based on Mayo Modified Wrist Score. Wrist motion in the flexion-extension plane loss averaged 18.4 degrees. Grip force increased significantly following treatment, with improvement totaling 15% of normal side. No complications were found in this series. Consequently, dorsal capsulodesis and ligamentoplasty with partial DRC ligament is considered a valuable therapeutic option for cases of pre-dynamic and dynamic SL instability.

An arthroscopic-assisted minimal invasive method for the reconstruction of the scapho-lunate ligament using a bone–ligament–bone graft

“…Nine of our patients had type 3 SL ligament injury, which causes a dynamic instability (Shih et al, 2003). Thus, the angular measurements of these patients were normal or only slightly increased preoperatively.…”

“…It is undetermined if our mini-invasive technique helps to correct the increased SL, radio-lunate and lunate-capitate angle seen in SL instability based on our study. Nine of our patients had type 3 SL ligament injury, which causes a dynamic instability (Shih et al, 2003). Thus, the angular measurements of these patients were normal or only slightly increased preoperatively.…”

Surgical outcomes of chronic isolated scapholunate interosseous ligament injuries: a systematic review of 805 wrists

“…35 Data were collected on 805 procedures from a total of 35 papers 25,[28][29][30][31][32] (Table 3). The review included 43 patients from 4 studies involving intentional fibrous nonunion type procedures, 32,41,48,61 391 patients from 14 groups involving capsulodesis, [29][30][31]39,43,47,51,52,54,55,59,60,62,63 319 patients from 12 groups involving tenodesis techniques 25,30,34,36,37,40,[44][45][46]50,53,58 and 51 patients from 4 groups using bone-tissue-bone techniques. 35,42,57,64 Overall, 68% of patients were male, and the patients' average age was 39 years (Table 4).…”

The role of arthroscopy in carpal instability

“…It is important to emphasise that there is a steep learning curve in not only assessing and interpreting arthroscopic findings in carpal instability (Figures 6 and 7), but in considering complex arthroscopically assisted procedures such as K-wire fixation (Garcia-Elias, 2006; Shih et al, 2003; Whipple, 1995), the reduction-association SL procedure (Aviles et al, 2007; Caloia et al, 2012), and arthroscopically-assisted dorsal capsulodesis (Binder et al, 2013). There is a need to gain experience and expertise by attending workshops and cadaveric courses to introduce these treatments safely in health care.…”

“…Arthroscopic electro-thermal shrinkage has also been shown to improve symptoms in around 80%-90% cases with partial tears 2 years after the procedure (Darlis et al, 2006;Hirsh et al, 2005;Shih and Lee, 2006). K-wire fixation with or without augmentation with dorsal capsulodesis has also been recommended for acute partial tears with about 80% excellent or good outcome (Garcia-Elias, 2006;Shih et al, 2003;Whipple, 1995). It is however, pertinent to reflect what the natural course would have been without any treatment at all (Mrkonjic et al, 2015).…”