Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave

Abstract

Purpose: To compare clinical and radiographic outcomes in patients with chronic scapholunate dissociation treated with a modified Brunelli technique versus a 4-bone tendon weave.

Methods: A retrospective cohort study was performed. Twenty-three patients presented with chronic scapholunate dissociation and were treated with the 4-bone tendon weave technique as described by Almquist and colleagues. A separate group of 21 patients were subsequently treated with a modified Brunelli plus reduction-assisted scapholunate ligament technique. All patients had preoperative radiographs demonstrating scapholunate ligament disruption and positive magnetic resonance arthrograms. All were treated by the senior surgeon (T.E.T.), who initially performed the 4-bone tendon weave and later the modified Brunelli procedure plus temporary screw fixation. Evaluation included radiographic changes, pain and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire scores, grip strength, and range of motion. Data were analyzed using the Wilcoxon signed rank test for preoperative-to-postoperative comparisons and the Wilcoxon-Mann-Whitney test for comparison between the 2 treatment groups.

Results: The scapholunate angle decreased in both groups (mean 15 degrees +/- 5 decrease for the Brunelli group; 10 degrees +/- 4 decrease in the 4-bone tendon weave group). Mean pain and DASH scores preoperatively and postoperatively demonstrated greater improvement for the modified Brunelli group (pain scores rated on a visual analog scale of 1 to 10: mean difference Brunelli group = 4.8 cm; 4-bone tendon weave group = 3.2 cm; mean difference 1.6 cm; DASH scores: mean difference Brunelli group = 31.5 points; 4-bone tendon weave group = 14.2 points). The Brunelli group also experienced greater postoperative motion as a percentage of preoperative motion (mean 86% +/- 7 vs 60% +/- 12) and significant increases in postoperative versus preoperative grip strength (mean 2 kg vs 1 kg; increase of 1 kg).

Conclusions: The modified Brunelli technique for scapholunate interosseous ligament reconstruction compared with the 4-bone tendon weave technique has improved outcomes in pain relief, DASH scores, range of motion, and grip strength at 2.5 years follow-up.

Type of study/level of evidence: Therapeutic III.