The role of three-ligament tenodesis in the treatment of chronic scapholunate instability

Abstract

Restoring ligamentous control in dissociative carpal instability is a major issue in protecting against osteoarthritis. We present clinical and radiological results for 20 patients who underwent flexor carpi radialis three-ligament tenodesis and were prospectively reviewed at a mean follow-up of 25.1 months. Three-ligament tenodesis significantly relieved pain and increased grip strength, wrist function at the expense of joint stiffness. This improvement was not seen in cases of dynamic instability. However, ligamentous loosening did result in rapid recurrence of radiological anomalies and frequent complications. This study challenges the long-term benefit of three-ligament tenodesis in both dynamic and static chronic scapholunate instability.

Outcomes of scapholunate intercarpal ligamentoplasty for chronic scapholunate dissociation: a prospective study in 26 patients

“…The mean scapholunate gap was 2.3 mm and SLA of 62° at the last follow-up. These values are in the range reported by other studies: 2.2 mm gap (Links et al., 2008) or 3.7 mm gap (Pauchard et al., 2013), and a mean of 50° of SLA in the report of Van Den Abbele et al. (1998) and 75° of Pauchard et al.…”

Additively Manufactured Multiphasic Bone–Ligament–Bone Scaffold for Scapholunate Interosseous Ligament Reconstruction

“…Currently, SLIL injuries are often reconstructed by “tenodesis,” whereby a tendon graft is inserted between the scaphoid and lunate in order to re‐establish their relationship and restore stability of the wrist joint . Although the current surgical techniques result in short‐term benefits and short‐term joint stability maintenance, the long‐term prognosis is poor, and the patients have a higher risk of developing arthritis …”

Radiological evaluation of scapholunate intercarpal ligamentoplasty for chronic scapholunate dissociation in cadavers

“…Recent studies (Chabas et al., 2008; De Smet and Van Hoonacker, 2007; Elgammal and Lukas, 2016; Ellanti et al., 2014; Links et al., 2008; Moran et al., 2006; Nienstedt, 2013) have shown medium-term recurrence of radiological anomalies (SL gap and DISI deformity) as a result of ligamentous loosening. Moreover, the 3LT, like the other FCR ligamentoplasties (Almquist et al., 1991; Bain et al., 2013; Brunelli and Brunelli, 1995; Linscheid and Dobyns, 1992; Ross et al., 2013; Van Den Abbeele et al., 1998), may result in iatrogenic complications from the transosseous scaphoid tunnel (Pauchard et al., 2013). Recent biomechanical studies have underlined the important stabilizing role of the dorsal intercarpal ligament (DICL), which, when sectioned, seems to cause the evolution from dynamic to static instability (Mitsuyasu et al., 2004).…”