Scapholunate Ligament Injuries: A Review of Current Concepts

Abstract

Injuries to the scapholunate ligament are common, especially among young active individuals. Surgeons are faced with a difficult problem because of imperfect surgical outcomes and the high demands of this patient population. Here, we review the current concepts and newest literature on scapholunate ligament injuries as well as the classification and treatment options for each stage of scapholunate instability. Emphasis is on stages in which reconstructive rather than salvage procedures can be performed. The natural history is poorly understood; it is unknown which and how many scapholunate injuries lead to wrist arthritis (SLAC wrist). Partial injuries are rare and in small studies did well with arthroscopic treatment. Complete injuries are graded based on the acuity of the injury, the presence and reducibility of scapholunate malalignment, and, finally, cartilage status. In acute injuries, anatomic repair usually leads to satisfactory results, and many authors augment the repair with a capsulodesis technique. In chronic injuries, the presence of static malalignment usually leads to inferior outcomes. Various techniques have been devised and improved over the years. These techniques appear to provide a more anatomic reconstruction, with less loss of motion; motion is 60-80 % of the contralateral side and grip strength averages 65-90 %. Once there is cartilage loss, the surgeon only has salvage procedures to choose from, tailored to the degree of arthritis.

Midterm Outcome of Bone-Ligament-Bone Graft and Dorsal Capsulodesis for Chronic Scapholunate Instability

“…Different treatment modalities have been developed for both dynamic and static lesions, but none has achieved reliable results. 24 Patients should ideally be able to return to their normal daily activities and work with a pain-free and functional wrist.…”

Scapholunate ligament reconstruction using the palmaris longus tendon and suture anchor fixation in chronic scapholunate instability

“…There is a paucity of evidence on the efficacy of different treatment methods for the management of SL ligament injuries as reported in a recent review 21. The authors also point out that it is desirable that validated patient-derived outcome measures be used in addition to objective data to assess overall efficacy.…”

Four-corner arthrodesis of the wrist using Variable Angle Locking Compression Intercarpal Fusion Plate (VA LCP ICF Plate; Synthes ® ): pre- and postoperative radiological analysis and clinical outcome in long-term evaluation

“…Persisting scaphoid non-unions and scapholunate ligament ruptures are the main causes for developing an insufficiency in carpal joint structure (carpal collapse, named as scaphoid nonunion advanced collapse = SNAC wrist or scapholunate dissociation advanced collapse = SLAC wrist respectively) [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16]. Watson and Ryu classified the severity of degenerative changes into three stages as shown in Table 1 (Tab.…”