Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation: a prospective observational study

Abstract

BackgroundScapholunate dissociation is the most common form of carpal instability. However, there is no gold standard for operative treatment. In this prospective observational study on 54 patients, a modified minimally invasive dynamic extensor carpi radialis longus tenodesis is described, which is characterized by a smaller approach and application of a cannulated screw and washer for tendon fixation.MethodsQuick-Disabilities of Arm, Shoulder and Hand (DASH)-questionnaire results, post-operative satisfaction, range of motion and grip strength are analyzed.ResultsA median Quick-DASH of 54.6 was observed pre-operatively which significantly improved to a median of 28.4 after the procedure (p < 0.001). Median follow-up was 24 months. Of 46 completely followed-up patients, 31 patients (67.4%) reported that they were satisfied with the outcome. Thirty-seven patients (80.4%) would recommend the procedure to a friend. Thirty-five patients (76.1%) reported some kind of complaint in the operated hand during follow-up. There was no association of severity of symptoms and co-morbidities with the outcome. Neither palmar flexion, nor dorsal extension was significantly different between the operated and non-operated wrist. The operated wrists were observed to have less grip strength than non-operated wrists.ConclusionsThe presented method seems to be as successful as other techniques described in literature. It is less invasive, thus more patient friendly without harming feasibility of future salvage options. However, post-operative complaint rate was quite high.

Extensor Carpi Radialis Longus Tenodesis Using a Biotenodesis Screw for Treatment of Symptomatic Geissler 2 Scapholunate Dissociation

“…In 2017, a modification of the original technique, using a smaller incision, a 4-mm screw, and a spiked washer, was published. 11 Again results were positive; however, the complication rate was high. In particular, 43.5% of patients reported screw head impingement, requiring screw removal.…”

“…7 Several operative techniques have been described, including arthroscopic debridement and thermal shrinkage 9 or extensor carpi radialis longus (ECRL) tenodesis to the dorsum of the scaphoid. [10][11][12] We present our surgical technique for a modified, minimally invasive technique of ECRL tenodesis with a polyetheretherketone (PEEK) anchor for treatment of Geissler grade 2 SLD, with our preliminary results using this method.…”

Scapholunate ligament reconstruction using a part of the extensor carpi radialis brevis tendon through a dorsal approach

“…Many previous studies fail to report either radiological data (Bajinski et al., 2017; Talwalkar et al., 2006), pain scales (Gandhi et al., 2016; Garcia-Elias et al., 2006; Kaltenborn et al., 2017) or combined scores, and others have a limited follow up period (Elgammal and Lukas, 2016; Van Den Abbeele et al., 1998). This makes comparison with our findings difficult.…”

Dynadesis for Treatment of Dynamic Scaphoid Instability with 20-Year Results

“…. ECRL tenodesis is a reliable option for the successful treatment of dynamic scaphoid instability.” Kaltenborn 41 modified Bleuler's technique, treated 46 patients with a mixed bag of instabilities, and followed them for 2 years. Bleuler and Kaltenborn both refer to their procedures as a tenodesis.…”