Abstract

ObjectivesThe purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.MethodsNineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists.ResultsTen of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.ConclusionsDelphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.Key Points• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability.• Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability.• Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.

Highlights

  • Instability of the scapholunate joint (SLJ) is usually caused by insufficiency of the scapholunate interosseous ligament (SLIL) and secondary stabilizers [1]

  • Wrist MR arthrography and computed tomography (CT) arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects

  • Literature research on diagnostic imaging of SLJ instability revealed a heterogeneous spread of scientific evidence between level 1 and level 5 according to criteria of the Oxford Centre for Evidence-Based Medicine (Table 5) [8]

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Summary

Introduction

Instability of the scapholunate joint (SLJ) is usually caused by insufficiency of the scapholunate interosseous ligament (SLIL) and secondary stabilizers [1]. There is an increasing body of research in the literature, there are substantial uncertainties regarding the optimal diagnostic imaging work-up of wrist instability in clinical practice [2, 3]. Increasing interdisciplinary understanding and cooperation between radiologists and hand surgeons might help identify the most appropriate wrist instability imaging approach and optimize treatments and clinical outcomes. A Delphi-based process was initiated by a small group of radiologists and hand surgeons to understand better the diagnostic performance of the various imaging techniques in wrist instability. The I-WRIST 2021 (International Wrist Radiologic evaluation for the Instability of the Scapholunate Joint and DRUJ/TFCC) group of radiologists and hand surgeons was established to provide interdisciplinary consensus statements on imaging of the two most frequent types of posttraumatic wrist instability that involves the SLJ and distal radioulnar joint (DRUJ)/triangular fibrocartilage complex (TFCC)

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