Ligamentization and Remnant Integration: Review and Analysis of Current Evidence and Implications for Scapholunate Reconstruction

Abstract

Background Scapholunate interosseous ligament injuries are common but remain a therapeutic challenge. Current treatment modalities prioritize restoration of normal anatomy with reconstruction where appropriate. To date no reconstructive technique has been described that discusses the potential benefit of preservation of the scapholunate ligament remnant. Little is known about the “ligamentization” of grafts within the wrist. However, a growing body of knee literature suggests that remnant sparing may confer some benefit. In the absence of wrist specific studies, this literature must guide areas for potential augmentation of current surgical practices. Objective The purpose of this study was to perform a review of the process of ligamentization and a systematic review of the current literature on the possible role of ligament sparring and its effect on ligamentization. Methods A systematic search of the literature was performed to identify all the studies related to remnant sparing and the ligamentization of reconstructed tendons, regardless of graft type or joint involved from MEDLINE, EMBASE, and PubMed until February 1, 2016 using the following keywords: ligamentization, graft, remodelling, reconstruction, biomechan*, histolo∗, scapholunate ligament. Each selected study was evaluated for methodological quality and risk of bias according to a modified Systematic Review Center for Laboratory Animal Experimentation criteria. Conclusions The available literature suggests that ligament sparring demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time. Clinical Relevance This review suggests that remnant sparing may be one way to improve outcomes of scapholunate ligament reconstructive surgery. Level of Evidence This is a level I/II, review study.

Current Concepts in Scapholunate Instability Without Arthritic Changes

“…Recently there is a trend towards more biological, less invasive reconstructions. Learning from knee ligamentization, it is suggested that ligament sparing demonstrated a trend toward improvements in vascularity, mechanoreceptors, and biomechanics that lessens in significance over time [ 78 ].…”

Retinaculum Grafts in Scapholunate Ligament Reconstruction: A Systematic Review

“…5 6 Additionally, the remodeling of a tendon graft after ligament reconstruction, or the process of ligamentization, affects the eventual biomechanical properties of the graft material as it progresses from the early graft healing phase with necrosis to the proliferative or remodeling phase and ending with the maturation phase. 7 8 In animal models, a clear end point to the third phase has not been defined, but a slow return of its cellularity to values of an intact anterior cruciate ligament (ACL) has been reported from between 3 and 6 months after ACL reconstruction. In human knees, these phases were more prolonged, and the process of ligamentization has been reported to occur for a period of between 9 and 18 months.…”