Treatment of Scapholunate Dissociation: Ligamentous Repair Associated with Modified Dorsal Capsulodesis

Abstract

We previously reported that our repair and/or reconstruction of the scapholunate interosseous ligament reduced the scapholunate dissociation and improved the clinical results. Re-evaluation of these patients after three years revealed that malrotation of the scaphoid advanced significantly although the clinical results declined only slightly. To prevent progression of scaphoid malrotation, a modified dorsal capsulodesis was subsequently added to the ligamentous repair of scapholunate dissociation. The records of 17 patients were available for this study. The time lapse from injury to surgical treatment ranged from four days to one year and six months. All but three patients were operated less than two months after the injury. All patients were followed for more than one year, with an average of 49 months. Clinical results were expressed by a modification of the point score method of Green and O'Brien. Scapholunate angles were measured on lateral X-ray films with the wrist in neutral position. Overall clinical results averaged 83 points (range: 25-100). The scapholunate angles averaged 49 degrees (range: 45-60). In the three patients, in whom the operation was performed more than 11 months after the injury, the clinical results averaged 38 points and scapholunate angles averaged 54 degrees, respectively. These clinical and X-ray results suggest that early repair of the scapholunate interosseous ligament along with a modified dorsal capsulodesis is a useful procedure in the treatment of scapholunate dissociation.

Scapholunate Ligament Injuries: A Review of Current Concepts

“…The SLIL is secured with horizontal mattress sutures [2,3]. Minami and Kaneda [32] reported on 12 direct SLIL repairs at a mean follow-up of 5 years and reevaluated those 3 years later [33]. The authors found deterioration of the clinical outcome as well as an increase in the SL angle from 50°to 60°.…”

Radiographic Evaluation of the Modified Brunelli Technique Versus the Blatt Capsulodesis for Scapholunate Dissociation in a Cadaver Model

“…Some of the techniques used today include repair of the SLIL, screw reduction, debridement, capsulodesis, tenodesis, bone-tissue-bone fixation, and combinations thereof. [7][8][9][10][11][12][13][14][15] The single most common surgical procedure performed for chronic SL instability with an irreparable SLIL without osteoarthritis in the United States and Canada is the Blatt capsulodesis (BC). 16 In 1987, Blatt described a dorsal capsulodesis to correct the excessive scaphoid flexion associated with SL dissociation.…”

Acute Lunate Dislocation in a Collegiate Football Player: A Case Review

“…The literature suggests that the most beneficial treatment for scapholunate dissociation is an early repair of the scapholunate interosseous ligament, which occurred in this case. 5 Although positive outcomes after lunate dislocations require a timely diagnosis and immediate surgical intervention, the extent of cartilage damage or associated wrist complex trauma may complicate recovery.…”