Outcomes of Capitohamate Bone-Ligament-Bone Grafts for Scapholunate Injury

Abstract

Purpose In an attempt to restore natural carpal kinematics more closely, boneligament-bone (BLB) grafts have been described for treating scapholunate (SL) injury. In this article we report the long-term results of capitohamate BLB autograft for the treatment of SL dissociation. Methods The medical records of patients treated with capitohamate BLB grafts for SL dissociation were retrospectively reviewed. Twenty-three patients were available for evaluation. Patients were sent a Disabilities of the Arm, Shoulder, and Hand (DASH) and a Patient-Rated Wrist Evaluation (PRWE) questionnaire and returned for exam. Thirteen patients returned the questionnaire, and 12 wrists were examined. Range of motion, grip strength, pain, complications, return to work, and radiographic parameters were documented. Results The average length of follow-up evaluation was 9.2 years. The average SL gap was 4.5 mm preoperatively and 3.6 mm at final follow-up. The average SL angle was 70 degrees preoperatively and 73 degrees at final follow-up. There was no statistically significant difference in preoperative versus postoperative flexion, extension, radial deviation, ulnar deviation, or grip strength. The average postoperative visual analog scale (VAS) score was 1.25 at rest and 3.58 with activity. The average Mayo Wrist Score was 66.8 preoperatively and 70.9 postoperatively (p ¼ 0.158). The average postoperative PRWE was 20.5, and average postoperative DASH was 15.1. At final follow-up, four patients had no radiographic evidence of arthritis. Two patients had evidence of earlystage radiocarpal arthritis, four had evidence of midcarpal arthritis, and two had radiographic evidence of mild scaphotrapeziotrapezoid arthritis. One patient required a salvage procedure with four-corner fusion. Discussion BLB reconstruction can be used to treat SL instability. At final follow-up, the majority of patients did not worsen clinically or functionally or require secondary salvage procedures; however, radiologic progression of arthritis was not prevented. These outcomes are comparable to midterm results of other SL reconstructive options; thus, we have abandoned this technique for other less technically demanding procedures.

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

“…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). In patients with identifiable traumatic events, the average time from injury to surgery was 19 months.…”

Significance of Scapholunate Gap Width as Measured by Probe from Midcarpal

“…Many authors that report on SL ligament repair or reconstruction differentiate between predynamic, dynamic, and static SL instability with or without dorsiflexed intercalated segment instability (DISI). [15][16][17][18] This radiographic classification takes into account the SL gap width on plain radiographs on rest and under stress. The more arthroscopic techniques developed with time, the more relevance arthroscopic classifications achieved.…”

Die modifizierte SLAM (scapholunate axis method) Technik zur sekundären SL-Band-Rekonstruktion – Erste Ergebnisse

“…Das postoperative Bewegungsausmaß zeigte sich in mehreren Studien vielversprechend, allerdings kommt es im Verlauf bei zwei Dritteln der Patienten zu arthrotischen Veränderungen, wie u. a. van Kampen und Mitarb. berichten [3,12,13]. Die Tenodese-Technik nach Brunelli gewährleistet eine hohe Stabilität.…”

“…Unsere Ergebnisse entsprechen diesbezüglich weitestgehend den Ergebnissen der SL-Bandrekonstruktion mit einem Knochen-Ligament-Knochen-Transplantat und denen der verschiedenen Tenodese-Techniken. Im Gegensatz dazu beklagen 60 % der Patienten nach dorsaler Kapsulodese persistierende Schmerzen [2,3,[5][6][7][11][12][13][14][15][16]. Im Rahmen unserer Studie konnte eine durchschnittliche Reduktion des DASH-Scores um 30 Punkte erzielt werden.…”