Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Jul;13(2):186-193.
doi: 10.1007/s11420-016-9525-5. Epub 2016 Oct 11.

Equivalent Clinical Outcomes Following Favored Treatments of Chronic Scapholunate Ligament Tear

Pengcheng Wang  1 , Jeffrey G Stepan  2 , Tonya An  1 , Daniel A Osei  1
Affiliations
Review

Equivalent Clinical Outcomes Following Favored Treatments of Chronic Scapholunate Ligament Tear

Pengcheng Wang et al. HSS J. 2017 Jul.

Abstract

Background: Optimal treatment of chronic scapholunate (SL) instability remains controversial. Many surgical techniques have been proposed with varied results in subsequent case series; however, there is limited evidence demonstrating the relative effectiveness of the different treatment options.

Questions/purposes: We conducted a systematic review of the English literature to compare outcomes from capsulodesis and ligament reconstruction for treatment of chronic scapholunate instability.

Methods: An electronic database search using keywords associated with scapholunate ligament instability was performed. A total of 511 studies were identified. All studies with scapholunate ligament tears >4 weeks after the initial injury were included in the review. Data extracted included patient demographics, wrist range of motion, and radiographic outcome measures.

Results: A total of 308 patients from 11 studies met the inclusion criteria and were included in the study. The average time to surgery from initial injury was 11 months. There was no significant difference in wrist flexion or extension after capsulodesis or reconstruction. The weighted mean for postoperative wrist extension/flexion was 56°/45.6° in the capsulodesis group and 40.9°/47.3° in the reconstruction group. Pooled means of SL angle and SL gap were 60.3° and 3.44 mm after capsulodesis and 56.5 and 2.72 mm after reconstruction, respectively.

Conclusions: This systematic review failed to demonstrate any significant difference in outcomes from capsulodesis or reconstruction for treatment of chronic scapholunate instability. However, the retrospective studies examined were notably heterogeneous in design with high estimates of variance. Further prospective trials are necessary to determine an ideal treatment strategy.

Keywords: brunelli; capulodesis; reconstruction; repair; scapholunate; scapholunate ligament; tenodesis.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest

Pengcheng Wang, MD, Jeffrey G. Stepan, MD, and Tonya An, MD, MA have declared that they have no conflict of interest. Daniel A. Osei, MD reports grants from NIH/NCATS KL2 TR000450 and grants from BJHF/ICTS Pilot Award, outside the work.

Human/Animal Rights

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

N/A.

Required Author Forms

Disclosure forms provided by the authors are available with the online version of this article.

Figures

Fig. 1
Fig. 1
Flowchart showing literature search and screening strategy for articles included in systematic review.
Fig. 2
Fig. 2
Average postoperative wrist flexion for all studies reporting range of motion data, categorized by surgical technique. Dotted lines represent weighted average for capsulodesis (blue) and ligament reconstruction (red).
Fig. 3
Fig. 3
Average postoperative wrist extension for all studies reporting range of motion data, categorized by surgical technique. Dotted lines represent weighted average for capsulodesis (blue) and ligament reconstruction (red).
Fig. 4
Fig. 4
Average postoperative scapholunate gap for all studies reporting radiographic data, categorized by surgical technique. Dotted lines represent weighted average for capsulodesis (blue) and ligament reconstruction (red).
Fig. 5
Fig. 5
Average postoperative scapholunate angle for all studies reporting radiographic data, categorized by surgical technique. Dotted lines represent weighted average for capsulodesis (blue) and ligament reconstruction (red).
See this image and copyright information in PMC

References

    1. Andreas S, Regula S. Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid. J Hand Surg. 2002;27:674–684. doi: 10.1053/jhsu.2002.34320. - DOI - PubMed
    1. Annie CL, Simon HC, Thanapong W, Thomas ET. Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg. 2008;33:850–856. doi: 10.1016/j.jhsa.2008.02.010. - DOI - PubMed
    1. Blatt G. Capsulodesis in reconstructive hand surgery. Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna. Hand Clin. 1987;3:81–102. - PubMed
    1. Blevens AD, Light TR, Jablonsky WS, et al. Radiocarpal articular contact characteristics with scaphoid instability. J Hand Surg. 1989;14:781–790. doi: 10.1016/S0363-5023(89)80076-0. - DOI - PubMed
    1. Burgess RC. The effect of rotatory subluxation of the scaphoid on radio-scaphoid contact. J Hand Surg. 1987;12:771–774. doi: 10.1016/S0363-5023(87)80066-7. - DOI - PubMed