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

Abstract

Background: Management of chronic isolated scapholunate interosseous ligament (SLIL) injuries has generated a substantial volume of low-quality literature with descriptions of multiple new surgical techniques, and the impact of instability pattern and the optimal surgical technique remain unclear. The primary goal of this review was to compare clinical, radiographic and patient-rated outcomes between current surgical techniques. Methods: We performed a systematic literature search using multiple databases. We analyzed clinical, radiographic and patient-reported outcomes. We used a fixedeffects model weighted by sample size with combined outcomes estimated via least squares means with 95% confidence intervals. We also performed a subgroup analysis of static versus dynamic instability. Results: We assessed 805 procedures from 37 study groups, with 429 procedures used in subgroup analysis. There were no statistically significant differences in outcomes between surgical techniques or in subgroup analysis. Overall, postoperative wrist flexion and pain scores decreased, and grip strength and patient-rated outcomes improved. Conclusion: Compared to overall preoperative values, modest improvements in pain score, grip strength and functional outcome scores were obtained from a range of reconstructive procedures performed for chronic isolated SLIL injuries. No significant differences could be ascertained between surgical techniques, potentially owing to the low quality of evidence and procedure heterogeneity. This study provides accurate preoperative reference values for future studies, highlights the controversial clinical impact of instability classification, and the need for higher-quality multicentre or collaborative trials to improve our understanding and management of this common injury. Contexte : La prise en charge des blessures chroniques du ligament interosseux scapho-lunaire (LISL) a généré un volume substantiel d'articles de faible qualité où sont décrites plusieurs nouvelles techniques chirurgicales, mais l'impact du modèle d'instabilité et la technique chirurgicale optimale restent à clarifier. Le principal objectif de cette revue était de comparer les résultats cliniques, radiographiques et autodéclarés par les patients entre les diverses techniques chirurgicales actuelles. Méthodes : Nous avons procédé à une interrogation systématique de la littérature dans plusieurs bases de données. Nous avons analysé les résultats cliniques, radiographiques et autodéclarés par les patients. Nous avons utilisé un modèle à effets fixes pondéré par la taille de l'échantillon, avec paramètres mixtes estimés par les moyennes des moindres carrés et des intervalles de confiance à 95 %. Nous avons aussi effectué une analyse de sous-groupes (instabilité radiographique dynamique c. statique). Résultats : Nous avons évalué 805 interventions dans 37 groupes étudiés, et 429 interventions ont été utilisées dans les analyses de sous-groupes. On n'a noté aucune différence statistiquement significative pour ce qui est des résultats entre...

Management of chronic scapholunate ligament injury

“…Comparison of the pre-and postoperative outcomes against uninjured side demonstrated a statistically significant improvement in mean grip strength (67.0% v. 82.6%), Disabilities of the Arm, Shoulder and Hand (DASH) score (42.2 v. 18.5) and Patient-Rated Wrist Evaluation (PRWE) score (79.6 v. 32.1). 15 There was also statistically significant reduction in the Visual Analogue Scale (VAS) score for pain (4.9 v. 3.0) and wrist flexion (52.3 v. 46.3 ) with p < .05 for all. 7 Radiological parameters (reported in 26 studies) showed a reduction of the SLG from 3.1 mm to 2.7 mm (p ¼ .05) whilst the SLA showed a change from 62 to 57.9 (p < .05).…”

“…In static instability the SLIL is injured along with the extrinsic ligaments and consequently, the above-mentioned features are seen in a standard radiograph, without the need for loading/stressing the joint. 7,15 In 1996, Geissler et al popularised the arthroscopic evaluation of SLIL using a 4-stage grading system. 16 Grade 1e3 of this intraoperative classification represent pre-dynamic instability whereas grade 4 is equivalent with dynamic instability.…”

“…11,15,20e29 In 2018, Montgomery et al set out to compare patient outcomes from current surgical techniques, performing subgroup analysis to establish whether there is a difference in outcomes between patients with static and dynamic instability. 15 Due to diversity of procedures, they were divided in four groups as shown in Table 1. 15 The first group included capsulodesis procedure, where a part of the wrist capsule or ligament is rearranged and reattached to the dorsum of scaphoid to act as restraint against flexion (Fig.…”

“…15 Due to diversity of procedures, they were divided in four groups as shown in Table 1. 15 The first group included capsulodesis procedure, where a part of the wrist capsule or ligament is rearranged and reattached to the dorsum of scaphoid to act as restraint against flexion (Fig. 4).…”

“…20 The last group included procedures that involved debridement and stabilisation of the scapholunate joint with a temporary or dynamic fixation (termed intentional fibrous non-union). 15,21 Their systematic review combined data from 35 papers providing a total sample size of 805 procedures, of which 391 patients from 14 studies who had capsulodesis, 319 patients from 12 studies who had tenodesis, 51 patients from 4 studies who had bone-tissue-bone technique and 43 patients from 4 studies who underwent "intentional fibrous non-union" type operations. Comparison of the pre-and postoperative outcomes against uninjured side demonstrated a statistically significant improvement in mean grip strength (67.0% v. 82.6%), Disabilities of the Arm, Shoulder and Hand (DASH) score (42.2 v. 18.5) and Patient-Rated Wrist Evaluation (PRWE) score (79.6 v. 32.1).…”