The EWAS Classification of Scapholunate Tears: An Anatomical Arthroscopic Study

Abstract

Scapholunate interosseous ligament (SLIOL) tears, according to the studies of Mayfield, develop in a predictable pattern after a trauma in extension, ulnar deviation, or intercarpal supination. The volar part of the scapholunate ligament is involved first, then the whole SLIOL, then the extrinsic ligaments such as the radioscaphocapitate (RSC) ligament and the radiotriquetral (RT) ligament with a variable degree of ligament damage. 1They occur mainly in young patients of working age, who may develop wrist instability, which can eventually lead to degenerative arthritis and a scapholunate advanced collapse (SLAC) wrist.2,3 Once arthritis has developed, the treatment of these lesions is not simple and generally requires salvage procedures with a significant loss of wrist function. Treatment of a chronic scapholunate ligament tear is still a challenge for the surgeon, even before wrist arthritis has developed, since it is not always possible to regain complete wrist strength, motion, and AbstractTreatment of scapho-lunate (SL) injuries is still a challenge for the surgeon, especially in chronic cases. The aim of the study isto experimentally cut, specific portions of scapholunate ligament and extrinsic ligaments and check their corresponding arthroscopic finding in order to understand the pathogenesis and develop a new classificationsystem which is an evolution of the present arthroscopic classifications. Materials and Methods Thirteen cadaver wrists were studied under arthroscopy. Different portions of the scapho-lunate ligament were subsequently sectioned. In group A the sectioning sequence was: anterior SLIOL, RSC, LRL, SLIOL's proximal and posterior, DIC, DRC ligament and ST ligaments (8 cases). In group B it was: SLIOL's posterior and proximal, DIC, SLIOL's anterior, LRL, RSCL, DRC, ST ligaments (5 cases). The anatomo-pathological findings after each sectioning were correlated to the classification system proposed (

Interdisciplinary consensus statements on imaging of scapholunate joint instability

“…The Garcia-Elias staging of SLIL injuries focuses on static and dynamic evaluation of the SLJ and the SLIL [ 6 ] (Table 2 ). This 6-stage scapholunate dissociation grading system evaluates SLJ dysfunction from the least to most advanced stages, including differentiation between complete and partial SLIL rupture with a normal dorsal scapholunate ligament, evaluation of SLJ alignment and reducibility and assessment of radiocarpal and midcarpal articular cartilage.…”

“…A preliminary list of four SLJ instability questions was developed (Table 1 ). The selected classifications were the Garcia-Elias, Lluch and Stanley staging [ 5 ] (Table 2 ), the European Wrist Arthroscopy Society (EWAS) classification [ 6 ] (Table 3 ) and the Van Overstraeten and Camus classification [ 7 ] (Table 4 ).…”

ACTION trial: a prospective study on diagnostic Accuracy of 4D CT for diagnosing Instable ScaphOlunate DissociatioN

“…The patients will not be exposed to radiation for research purposes. Arthroscopy will be performed as the diagnostic gold standard within the same week to classify the type of SLL tear according to the European Wrist Arthroscopy Society (EWAS) and Geissler [16,17]. Primary reconstruction and temporary arthrodesis will be performed when necessary, but the surgical therapy will not be part of the study.…”

“…Secondly, through the midcarpal ulnar (MCU) and midcarpal radial (MCR) portals the SLL tear will be classified. Surgical reports will be descriptive, but they will include a final EWAS/Geissler classification to describe stability of the SL joint on a case report form (CRF) [16,17]. The following data will be documented by hand surgeons on paper CRFs [Table 4].…”

Optimal management of scapholunate ligament injuries

“…A grade IV lesion is a complete scapholunate injury with passage of the arthroscope possible from the midcarpal to the radiocarpal joint. A grade V lesion is a wide scapholunate diastasis, which allows passage of the arthroscope through the scapholunate joint and is seen on static radiograph to show an increased gap and DISI deformity 45. Dynamic testing can be performed during arthroscopy to further evaluate the severity of injury, which may not show on imaging.…”