Comparison of Outcomes of Scapholunate Ligament Reconstruction Techniques

Abstract

Introduction Injury to the scapholunate interosseous ligament (SLIL) is a common cause of carpal instability, yet surgical management of chronic SLIL disruption remains challenging with no optimal technique identified. Purpose The purpose of this meta-analysis was to comparatively review the available evidence of clinical, radiographic, and patient-reported outcome measures among popular techniques of SLIL reconstruction (capsulodesis, tenodesis, and bone-tissue-bone graft) to better guide management of SLIL injuries. Methods A total of 1,172 patients from 42 included studies were assessed. Standardized data extraction and analysis were performed. The mean of postoperative outcome assessments with standard deviation was used to calculate pooled standardized mean difference with 95% confidence interval. Results Visual Analog Scale (VAS) score for postoperative pain was lowest in bone-tissue-bone patients at 0.9 ( p = 0.0360). Bone-tissue-bone patients had the highest percentage of "excellent" functional outcomes at 64.5% ( p < 0.0001). Disabilities of the Arm, Shoulder, and Hand (DASH)/QuickDASH score was best in bone-tissue-bone patients at 9.7 ( p < 0.0001). Patient-Rated Wrist Evaluation (PRWE) score was best in tenodesis patients at 37.8 ( p = 0.0255). There were no statistically significant differences in grip strength, range of motion, or radiographic outcomes among the techniques. Conclusion Existing data demonstrate some benefit of bone-tissue-bone reconstruction over capsulodesis and tenodesis in pain reduction and functional improvement of the injured wrist. No statistically significant differences among radiographic outcomes could be ascertained, possibly attributable to the heterogeneity of procedures. This review provides an updated reference and highlights the need for multicenter trials with longer term follow-up and more standardized outcome measures.

Keywords: capsulodesis; reconstruction; repair; scapholunate ligament/instability; tenodesis.

Fig. 1

Flowchart of literature search and study selection process resulting in 42 eligible articles with 1,172 patients total.

Fig. 2

Studies examining capsulodesis, tenodesis, and bone-tissue-bone reconstruction demonstrating weighted means of postoperative visual analog scale (VAS) pain score with 95% confidence interval (CI).

Fig. 3

Studies examining capsulodesis, tenodesis, and bone-tissue-bone reconstruction demonstrating weighted means of postoperative Disabilities of the Arm, Shoulder, and Hand (DASH)/QuickDASH score with 95% confidence interval (CI).

Fig. 4

Studies examining capsulodesis, tenodesis, and bone-tissue-bone reconstruction demonstrating weighted means of postoperative Patient-Rated Wrist Evaluation (PRWE) score with 95% confidence interval (CI).

Fig. 5

Studies examining capsulodesis, tenodesis, and bone-tissue-bone reconstruction demonstrating number of events for patient-reported “excellent” outcomes with 95% confidence interval (CI).