Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results

Abstract

Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained. Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded. Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

Keywords: acute injury of the scapholunate ligament; arthroscopy; dorsal capsular reinforcement; scapholunate ligament complex.

Fig. 1

Arthroscopic portals: 3 to 4, 6R, midcarpal ulnar (MCU) and midcarpal radial (MCR).

Fig. 2

( A, B ) View from the 6R portal. Introduce a 2.2-mm Micro Corkscrew suture anchor (Arthrex, Naples, FL) in the dorsal and proximal margins of the scaphoid or lunate bone, depending on where the SLL has detached. ( C, D ) Using a TFCC SutureLasso of 70° (Arthrex, Naples, FL) from 3 to 4, cross the remains of the SLL from dorsal to proximal, recovering the nitinol loop through the same portal. L, lunate; R, radius; SC, scaphoid; SLL, scapholunate ligament; TFCC, triangular fibrocartilage complex.

Fig. 3

( A, B ) View from the 6R portal. Pass one of the ends of the implant suture through the rest of the SLL with the help of the nitinol loop. ( C, D ) The two ends of the suture are tied with a sliding knot over the implant, leaving a simple stitch through the SLL and do not cut the tied sutures. L, lunate; R, radius; SC, scaphoid; SLL, scapholunate ligament.

Fig. 4

( A, D ) View from the MCU portal. Through the 3 to 4 portal an 18G caliber needle with a nylon suture inside is introduced, aiming it from the proximal edge of the SLL to the midcarpal joint, through the ligament's tissue. ( B, E ) The nylon suture is recovered through the MCR portal. ( C, F ) This nylon suture is used to pass one of the implant suture ends through to the midcarpal space to the MCR portal. MCR, midcarpal radial; MCU, midcarpal ulnar; SLL, scapholunate ligament.

Fig. 5

( A–C ) The MCR suture is recovered from the 3 to 4 portal incision through the space in between the dorsal capsule and the extensor tendons; ( D–F ) With the scope in the 6R portal, the implant sutures are tied again, withdrawing the traction. The closure of the dorsal SL interval with the capsular plication performed by reconstructing the dorsal capsuloligamentous union of the scapholunate ligament complex can be seen. MCR, midcarpal radial; SL, scapholunate.

Fig. 6

Evaluation of pain using the visual analog scale before the surgery (0 months) and during the postoperative course (6 and 12 months). The data are expressed as mean ± SEM. Significantly different, ** p  < 0.01, *** p  < 0.001.

Fig. 7

Evaluation of grip strength before the surgery (0 months) and during the postoperative course (6 and 12 months). The results are expressed as absolute values ( A ) and as a reduction in percentage compared with normality ( B ). Significantly different, ** p  < 0.01, *** p  < 0.001.

Fig. 8

Evaluation of range of joint motion ( in degrees ) before the surgery (0 months) and during the postoperative course (6 and 12 months). Significantly different, ** p  < 0.01, *** p  < 0.001.

Fig. 9

Results of the functional evaluation with the QuickDASH Score before the surgery (0 months) and during the postoperative course (6 and 12 months). Significantly different, ** p  < 0.01, *** p  < 0.001.

Fig. 10

Results of the functional evaluation with the Mayo Wrist Score before the surgery (0 months) and during the postoperative course (6 and 12 months). Significantly different, *** p  < 0.001.

Fig. 11

Clinical case. ( A, B ) Perilunate dislocation; ( C, D ) X-ray result after arthroscopic reduction and scapholunate suture. ( E, F ) X-ray results after 12 months of follow-up.