Dorsal scapholunate ligament injury: a classification of clinical forms

Abstract

The dorsal scapholunate (SL) ligament may disrupt in variety of ways. Each form of injury requires specific fixation. To investigate the incidence of each type of ligament failure, the records of 45 patients with adequate information, good quality pictures, or videos demonstrating injury characteristics were reviewed. Four types of SL injury were found: type 1 (lateral avulsion from the scaphoid) was the most frequent, present in 19 patients (42%); type 2 (medial avulsion from the lunate) was the least frequent, with 7 cases (16%); type 3 (mid-substance rupture) was found on 9 occasions (20%); and type 4 (partial rupture plus elongation) was observed on 10 occasions (22%). Based on our observations, we submit that an arthroscopically assisted SL capsuloplasty may not be possible in all cases, particularly not when the ligament has avulsed off the bone (60% of the cases), leaving no ligament remnant on one side. Most patients will require ligament reattachment techniques using transosseous sutures, bone anchors, or ligament reconstruction.

Efficacy of Magnetic Resonance Imaging and Clinical Tests in Diagnostics of Wrist Ligament Injuries: A Systematic Review

“…Furthermore, MRI is unable to describe the classification of the total SL ligament injury according to the new AnderssoneGarciaElias classification of clinical forms of SL ligament rupture. 24 As a result, MRI cannot be used to estimate the prognosis, the capacity for healing, and the operation that should be recommended.…”

“…Overlooked SL ligament injuries lead to scapholunate advanced collapse of the wrist and arthritic changes, with pain, loss of range of motion, and strength as a result. 24 A substantial degree of delayed presentation of DRUJ instability after wrist fracture and/or sprains in children and adolescents is not unusual, and a considerable delay from initial injury to final diagnosis in patients with TFCC injury and DRUJ instability is common. For this reason, we need to improve the methods for examining these patients.…”

Treatment of scapholunate ligament injury

“…According to the thesis by Andersson in 2016 48 and Andersson and Garcia-Elias in 2013, 49 we still need to take another factor into account. None of the questions above mention the different types of ligament rupture as a factor to consider.…”

When can a professional athlete return to play following scapholunate ligament delayed reconstruction?

“…This is followed by a progressive disruption of the scapholunate interosseous ligament complex, which typically starts volarly and progresses dorsally, completing the scapholunate dissociation 9. The degree of disruption to the intracarpal ligaments have been classified based on their arthroscopic appearance, please see web appendix for table detailing this arthroscopic classification (see online supplementary table S1) 10…”