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Review
. 2023 Dec;48(12):1252-1262.
doi: 10.1016/j.jhsa.2023.06.016. Epub 2023 Aug 14.

Scapholunate Instability: Diagnosis and Management - Classification and Treatment Considerations - Part 2

Affiliations
Review

Scapholunate Instability: Diagnosis and Management - Classification and Treatment Considerations - Part 2

Lauren Elisabeth Wessel et al. J Hand Surg Am. 2023 Dec.

Abstract

Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this Current Concepts article reviewed the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical stabilizers. In this section, we provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. These updates clarify the importance of the critical stabilizers of the scapholunate interval, ligament-specific considerations in scapholunate ligament reconstruction, and the risks of ligament disinsertion when surgically exposing the dorsal wrist. We propose a ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.

Keywords: Carpal instability; dorsal intercalated segment instability (DISI); scapholunate advanced collapse (SLAC); scapholunate instability; scapholunate ligament.

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