Classification arthroscopique des lésions du septum capsulo-scapholunaire dorsal (DCSS)

Abstract

The dorsal capsulo-scapholunate septum (DCSS) is an anatomical structure linking the scapholunate ligament and the dorsal capsule of the wrist. It should be a predynamic scapholunate stabiliser. The authors, using their experience for the extrinsic ligaments testing, suggest an arthroscopic testing of the DCSS. The status could be graded in four stages according to the trampoline aspect and to the fiber attachment: stage S0: the DCSS presents an intact aspect. It is normally tensed when palpated with a probe. All the fibers are continuous, with a typical aspect of cathedral arches. Stage S1: the DCSS is loosened when palpated with a probe. It presents partial detachments on the distal insertion with more than 50% continuous fibers. Stage S2: the DCSS is loosened when palpated with a probe. It presents partial detachment on distal insertion with less than 50% continuous fibers. Stage S3: the DCSS is totally torn. The scope introduced through MCR can pass directly from midcarpal to radiocarpal spaces. They report a preliminary study on a series of 53 arthroscopies made between January 2014 and December 2015 with evaluation of SL instability and DCSS laxity. There is a significant correlation between the lesional stage of the DCSS and the arthroscopic pre-dynamic scapholunate instability stage (P < 0.01) This study allows completing the spectrum of ligament lesions within injured wrists to adapt the best ligament repair as possible.