Results of the Modified Brunelli Tenodesis for Treatment of Scapholunate Instability: A Retrospective Study of 19 Patients

Chabas, Jean-François; Gay, A.; Valenti, David; Guinard, D.; Legré, R.

doi:10.1016/j.jhsa.2008.05.031

Cited by 95 publications

(78 citation statements)

References 47 publications

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“…They did record radiographic data and presented a final followup SL gap of 2.4 mm. 16 Their preoperative gap was 2.8 mm. They noticed an increase in the SL angle in the group with a follow-up greater than 36 months.…”

Section: Discussionmentioning

confidence: 93%

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Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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The purpose of this study was to examine the radiographic outcomes of dorsal intercarpal ligament capsulodesis (DILC), documenting the time to carpal collapse postoperatively. From January 2008 to January 2011, 12 patients were identified with chronic scapholunate (SL) dissociation. The average follow-up period was 15.8 months.Paired t-tests were used preoperatively, one month after pin removal, and at final followup to determine significance in radiographic outcomes. The Disabilities of the Arm, Shoulder, and Hand (DASH) survey was administered to patients before and after surgery to assess subjective levels of pain, function, and satisfaction. Intraoperatively all deformities were reduced completely. One month after pin removal, the mean SL gap was 3.3 mm, the SL angle was 74°, the radiolunate (RL) angle was 17°, and the lunatocapitate (LC) angle was 8°. Only the SL angle improved; the other measurements remained unchanged. At final follow-up, the mean SL gap was 3.6 mm, the SL angle was 78°, the RL angle was 20°, and the LC angle was 10°. SL angle worsened, but with no statistically significant difference. The other radiographic measurements remained unchanged at final follow up. Wrist flexion and extension decreased from 76% and 69% of the contralateral side to 62% and 56% of the contralateral side after surgery. Grip strength was 64% of the contralateral side before surgery and 83% after surgery. Visual Analog Scale (VAS) results improved from 6.3 to 1.7, and DASH scores improved from 39 to 8 after the surgery. DILC cannot withstand large and repetitive forces. Carpal collapse recurred within a short time after DILC. However, our small patient numbers and short term follow-up preclude any conclusions with respect to clinical efficacy of this procedure. Limitations of this study include the fact that this is a retrospective study with no control group. In addition, it represents a single-surgeon series, which introduces a source of bias and carries the risk of technical and methodological flaws, which may have contributed to the observed radiographic outcomes.

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Section: Discussionmentioning

confidence: 93%

“…Static SL dissociation was seen on the left side in 2 patients and on the right side in 10 patients. The time from injury to surgery averaged 8 months (range: [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. The average follow-up period after surgery was 15.8 months (range: 13-34).…”

Section: Methodsmentioning

confidence: 99%

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

2013

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“…[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Further data in a larger cohort of patients with a longer follow-up is required to determine the effect on SLAC-wrist deterioration.…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Dorsal Capsuloligamentous Repair in the Treatment of Chronic Scapholunate Ligament Tears

García-Elias¹,

Mathoulin²

2014

Articular Injury of the Wrist

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Introduction Scapholunate ligament injuries usually result due to a fall on the outstretched hand leading to scapholunate instability. The natural history of untreated scapholunate instability remains controversial and usually results in late arthritic changes-the so-called "SLAC" wrist. The advent of wrist arthroscopy helps in early diagnosis and treatment of these serious injuries. In selected cases with reducible scapholunate instability (Garcia-Elias stages 2, 3 and 4) we propose a new "all arthroscopic dorsal capsulo-ligamentous repair" with the added advantage of early rehabilitation and prevention of post-operative stiffness. Material and MethodsWe report the results of our series of 57 consecutive patients suffering from chronic wrist pain refractory to conservative measures. All patients underwent a thorough clinical examination in addition to a standard set of radiographs and MRI exam; and they were treated by an all-arthroscopic dorsal capsulo-ligamentous repair under loco-regional anesthesia on an ambulatory basis. All patients were available for follow-up at regular intervals during the post-operative period. At follow-up, the wrist ROM in all directions, the grip strength, DASH questionnaire and pain relief based on the VAS were recorded for both-the operated and contra-lateral sides. Results There were 34 males & 23 females with a mean age of 38.72 AE 11.33 years (range 17-63 years). The dominant side was involved in 52 cases. The mean time since injury was 9.42 AE 6.33 months (range 3-24 months) and the mean follow-up was 30.74 AE 7.05 months (range 18-43 months). The mean range of motion improved in all directions. The mean difference between the post-and pre-operative extension was 14.03°(SEM ¼ 1.27°; p < 0.001); while the mean difference between the post-and preoperative flexion was 11.14°(SEM ¼ 1.3°; p < 0.0001) with flexion and radial deviation reaching 84.3% and 95.72% respectively of the unaffected wrist. The mean difference for the VAS score was -5.46 (SEM ¼ 0.19; p < 0.0001). The mean post-operative grip strength of the affected side was 38.42 AE 10.27 kg (range 20-60 kg) as compared with mean pre-operative grip strength of 24.07 AE 10.51 kg (range 8-40 kg) (p < 0.0001). The mean post-operative grip strength of the operated side was 93.4% of the unaffected side. The DISI was corrected in all cases on post-operative radiographs. The mean

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“…Despite its merits, longer term follow up studies of the MBT have shown widening of the SL gap and angle, and biomechanical studies have demonstrated that the MBT and other techniques fail to reliably restore carpal kinematics and alignment [26,28]. We feel that the main issue with the modified Brunelli approach is that the fixation of the tendon graft is poor in both the lunate and in reconstructing the DIC.…”

Section: Expected Outcomesmentioning

confidence: 94%

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2017

OPROJ

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Results of the Modified Brunelli Tenodesis for Treatment of Scapholunate Instability: A Retrospective Study of 19 Patients

Cited by 95 publications

References 47 publications

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Radiographic Evaluation of Chronic Static Scapholunate Dissociation Post Soft Tissue Reconstruction

Arthroscopic Dorsal Capsuloligamentous Repair in the Treatment of Chronic Scapholunate Ligament Tears

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