Arthroscopic transosseous modified Mathoulin dorsal scapholunate capsulodesis – feasibility study and preliminary series of 10 patients

Abstract

Objective There is no common trend concerning arthroscopic repair for chronic scapholunate ligament tears, especially when no remnant ligament subsists. The aim of this study was to assess the feasibility of an arthroscopic transosseous dorsal scapholunate capsulodesis. Material and method Our series consisted of 10 patients presenting scapholunate tears EWAS stage IIIC for 8 patients and EWAS stage IV for 2 patients. Arthroscopic portals (MCU, MCR, 1–2 and 6R) and an 1 cm 3–4 portal with no capsulotomy were used. After arthroscopic debridement of the scapholunate area two 1 mm k-wires were passed through 3–4 portal into scaphoid and lunate. Two tunnels were performed using 2.4 mm canulated drills guided by the k-wires under arthroscopic control. A fiberwire was passed through those 2 tunnels and was knotted tight on the dorsal capsule. At the end of the procedure wrist was casted in light extension for 6 weeks. Rehabilitation started at the end of this period. Results At the latest follow-up (mean 8 months) we noticed significant pain relief, significant qDASH improvement and better grip strength for 8 patients. One developed a regional complex pain syndrome. Radiologically, there were no fractures and no scaphoid or lunate osteonecrosis. Conclusions Despite the weaknesses of our preliminary series with short follow-up and only few patients our results showed a significant clinical improvement. Nevertheless, the results should be confirmed with a bigger comparative series and a longer follow-up especially for the assessment of late osteoarthritis.