Abstract
Introduction The scapholunate interosseous ligament binds the scaphoid and lunate together, and is the primary stabilising ligament between these two bones. Scapholunate injuries lead to chronic instability and degenerative arthritis of the wrist. Scapholunate injuries are graded based on the acuity and the severity of the injury. Purpose The paper is a review of various techniques used to repair or reconstruct the scapholunate ligament according to the clinical manifestations, anatomic and pathologic findings. Methods A review of the literature covering this topic is presented. Results Conservative treatment is primarily indicated in stable and partial ligament tears. Arthroscopic treatment is used when immobilization is unsuccessful. Arthroscopically assisted scapholunate reduction and K-wire fixation is commonly used for acute injuries. Primary repair of scapholunate injuries are performed in all tear types using an open approach. Surgical indications depend on the severity of the instability, time after trauma and the presence of degenerative changes. Acute repair of scapholunate ligament injuries remains the gold standard as an earlier intervention provides better results. Acute injuries to the scapholunate ligament require two-four weeks before surgery. Within this period the ligament is often still repairable itself both with or without supplementary capsulodesis procedures; ligament reconstruction is generally preferable in patients with chronic injures. There are many arthroscopic techniques to treat chronic scapholunate injures such as scapholunate ligament primary repair using various types of capsulodesis, tendon graft reconstruction, bone-ligament-bone procedure, various intercarpal fusions and proximal row carpectomy, total wrist fusion and arthroplasty. Conclusion Early diagnosis and management of scapholunate ligament tears are necessary to preserve wrist functions.
Highlights
ResultsArthroscopic treatment is used when immobilization is unsuccessful
Diagnosis and treatment of injuries to the scapholunate ligament (SLL) is a common and well-researched topic in the medical literature of our country and CIS countries [1–6]
Early clinical and radiological presentation may be subtle, and instability can be identified with the use of advanced imaging modalities (MRI, arthroscopy of the wrist) that are not common in detection of wrist injuries in Russia
Summary
Yao et al.) [40] Loosening of the screw, development of arthritis (M.P. Rosenwasser) [36] Inconsistent SLL space and angle (A.Weiss) [7]; strength of 3rd carpalmetacarpal joint graft is comparable with that of the SLL (I.J. Harvey) [36] Improved pain at motion [7, 13]. S. Ioshida et al recommended scapholunate temporary fixation for ligament injuries combined with distal radius fractures reporting an improvement in the Mayo wrist score with pinning [48]. Acute injuries of the SLL can be repaired with the arthroscopic technique using bone anchors or by open surgery with capsulotomy [9, 20]. V. Garratala et al showed the advantage of the arthroscopic technique over open procedure for SLL repair with bone anchors and capsulodesis avoiding injuries to the periarticular soft tissue and the posterior interosseous nerve [20]. SLL reconstruction cannot be considered in the case and a wide range of salvage procedures are available for patients with advanced wrist arthritis. Total wrist arthrodesis provides reliable pain relief and stability, improves pain and quality of life with loss of flexibility and motion with a fused joint if no joint-sparing treatment can be offered [4]
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