Dorsal intercarpal ligament capsulodèse – comparaison des STT et triquetral option

Abstract

The purpose of this retrospective study is to assess the treatment of pre-dynamic and dynamic scapholunate instability using the dorsal intercarpal ligament (DIL) caspulodesis performed in two different ways: one leaving the triquetral part of the DIL attached, and the other sparing the STT origin. Between April 2014 and November 2016, a total of 14 patients with SL dissociation grade II, IIIA, IIIB, IIIC according to the arthroscopic classification were treated using in half cases the DIL leaving attached the triquetral part and in the remaining cases the DIL sparing the STT origin. A mean follow-up of 24 months (range 8–26) was considered. Pain, flexo-extension, grip strength, Mayo Wrist Score and Dash were measured before and after surgery. Wrist arthroscopy was done in all patients before open surgery to assess the status of the radio-carpal joint and to grade the SL instability according to the EWAS classification of scapholunate tears. All the patients gave a history of trauma and the mean period from the injury to the surgical treatment was 12 months (range 4–18). The dominant hand was affected in nine patients (64%). The mean score of pain before surgery was six by Visual Analogue Scale (VAS). Arthroscopic results demonstrated stage II (2 cases), stage IIIA (4 cases), stage IIIB (6 cases), stage IIIC (2 cases). In all the cases, the DIL were inserted by using a suture anchor. Postoperative complications, such as K-Wire infection has been recorded in one patient and one case of CRPS has been observed. Twelve patients were able to return to their previous work. Even if in both technique has been observed a mean Mayo Wrist Score improvement, the STT attachment variant ROM demonstrated a flexo-extension improvement of 82% and 74% with the triquetral attachment variant. Grip strength demonstrated 85% improvement with STT variant and 79% with triquetral attachment variant. Based on the present study, we conclude that dorsal caspulodesis by using both variant of the dorsal intercarpal ligament is a good surgical option in the treatment of pre-dynamic and dynamic scapholunate dissociation with better improvement in grip strength using the triquetral attached DIL technique and better ROM by using the STT attached DIL technique. Thus allowing a corresponding answer to the different functional and work demands of the patients. The two variant of DIL capsulodesis allows a better answer to different functional and work's demand.