Arthroscopic Interposition Tendon Arthroplasty for Stage 2 Scapholunate Advanced Collapse

Abstract

To report and analyze the functional outcomes of arthroscopic interposition tendon arthroplasty (AITA) in stage 2 scapholunate advanced collapse (SLAC). Sixteen patients with stage 2 SLAC who underwent AITA between 2009 and 2014 with a minimum of 24-month follow-up were retrospectively evaluated. Medical records were assessed for preoperative and postoperative range of motions, grip strength, visual analog scale, disabilities of the arm, shoulder, and hand (DASH) score, scapholunate angle, and scaphoid fossa-to-scaphoid space. After exclusion of 2 patients, 14 patients were available for this study. At final follow-up, improvements were found for the following variables: extension (preoperative mean, 49.29°; VS postoperative mean, 61.07°; P= .025, 95% confidence interval [CI], 1.74-21.85), radial deviation (preoperative mean, 6.43°; postoperative mean, 17.14°; P < .001, 95% CI, 6.06-15.36), grip strength (preoperative mean, 18.93kg; postoperative mean, 29.64kg; P < .001; 95% CI, 6.81-14.61), visual analog scale (preoperative mean, 8.07; postoperative mean, 2.50; P < .001; 95% CI,-6.52 to-4.61), and DASH (preoperative mean, 60.39; postoperative mean, 10.28; P < .001, 95% CI,-43.04 to-57.28), scapholunate angle (preoperative median, 67.50°; postoperative median, 55.00°, P= .002, Z=-2.831), and scaphoid fossa-to-scaphoid space (preoperative median, 0.00mm; postoperative median, 1.00mm; P < .001, Z=-3.145). There was no improvement in flexion (preoperative mean, 40.00°; postoperative mean, 50.00°;P= .025; 95% CI,-4.45 to -24.45), ulnar deviation (preoperative median, 25.00°; postoperative median, 30.00°;P= .063, Z=-2.060), or flexion-extension arc (preoperative mean, 89.28°; postoperative mean, 111.07°; P= .067; 95% CI,-1.79 to-45.36) following AITA. Nine of 13 patients were satisfied with the procedure, 3 were moderately satisfied, and 1 was not satisfied. Arthroscopic interposition tendon arthroplasty is an acceptable procedure for stage 2 SLAC. This procedure preserves motion, yields acceptable functional outcome, and reduces pain. Level IV, therapeutic case series.