Postoperative Pain Is Correlated with Scaphoid Dorsal Translation following Scapholunate Interosseous Ligament Reconstruction

Abstract

Background Dorsal scaphoid translation (DST) has been demonstrated to occur in patients with complete scapholunate interosseous ligament (SLIL) tears. Radiographs and magnetic resonance imaging (MRI) have demonstrated ability to detect DST in patients with documented complete scapholunate (SL) disruption, but the relevance of this parameter to outcomes of reconstruction has not been determined. Purpose The purpose of this article is to determine how radiographic parameters of SL dissociation correlate with postoperative pain and functional outcomes of SLIL reconstruction. Methods We performed a retrospective review of prospectively collected data on a cohort of 14 patients who underwent SLIL repair or reconstruction. Preoperative data included radiographic measurements of carpal posture and alignment (SL angle, radiolunate [RL] angle, SL gap, and DST), self-reported measure of average pain on a numerical rating scale (NRS) of 0 to 10, and the patient rated wrist evaluation (PRWE) survey. Postoperatively, the same data were collected at each follow-up visit. Radiographic parameters were statistically compared with postoperative NRS pain score and PRWE scores. Statistical correlations were calculated using Spearman's correlation coefficient, and mean NRS pain scores were compared using Wilcoxon's rank-sum tests, with an α value of p = 0.05. Results Mean NRS pain scores improved significantly after surgery. Mean DST improved significantly after surgery. The presence of postoperative dorsal scaphoid translation (DST) correlated strongly with postoperative pain. SL angle, RL angle, and SL gap showed no correlation with patient reported pain. There was no correlation with any radiographic parameter and PRWE. Conclusions Our study demonstrates that the presence of DST in postoperative radiographs has a strong correlation with patient reported pain following SLIL reconstruction. We conclude that correction of dorsal translation of the scaphoid is a more sensitive predictor of postoperative pain relief than SL gap, RL angle, or SL angle. Level of evidence This is a Level IV study.

Open Volar STT Ligament Reconstruction to Augment the Mathoulin's Arthroscopic Dorsal Capsuloligamentous Reconstruction: Technique Description and Case Reports

“…4 21 22 23 24 25 Lack of control of sagittal rotation of the scaphoid is necessary for the state of dorsal scaphoid subluxation, which is associated with ongoing symptoms following scapholunate reconstruction. 15…”

“…4,[21][22][23][24][25] Lack of control of sagittal rotation of the scaphoid is necessary for the state of dorsal scaphoid subluxation, which is associated with ongoing symptoms following scapholunate reconstruction. 15 It is possible that the combination of the ADCLR and the volar STT ligament reconstruction is adequate to control scaphoid malrotation in higher grade instabilities (Garcia-Elias grade 5 or EWAS grade V). The volar STT reconstruction is also straightforward, and would appear to have minimal potential for iatrogenic problems.…”

“…2 Persistent dorsal scaphoid subluxation has been recently shown to correlate with persistent symptoms following scapholunate reconstruction. 15 Based on the results in Mathoulin's study, our indication for using the ADCLR alone is symptomatic scapholunate instability without radiographic malalignment with arthroscopic confirmation of scapholunate widening (European Wrist Arthroscopy Society [EWAS] grade IIIB/IIIC/IV). Reconstruction of the volar STT ligaments has the potential to provide additional rotational control of the scaphoid, when Mathoulin's ADCLR is used in higher grade scapholunate instability, when static malalignment is evident and found to be reducible in traction, either arthroscopically or radiographically and with normal articular surfaces arthroscopically.…”

Anatomical front and back reconstruction sustains radiographic alignment: a comparison to three-ligament tenodesis

“…This study did not measure RLA, RSA or DST (Sandow and Fisher, 2020). Recently, increased attention has been drawn towards techniques that address DST, as it is the only radiographic parameter that correlates with postoperative pain following scapholunate repair or reconstruction (Vutescu et al., 2020). In a cadaver study of 15 specimens with surgically-induced Stage 5 scapholunate dissociation, ANAFAB was demonstrated to significantly improve DST, whereas TLT and reduction and the reduction and association of the scaphoid and lunate (RASL) technique did not demonstrate this improvement (Burnier et al., 2021).…”