Modified minimally invasive extensor carpi radialis longus tenodesis for scapholunate dissociation: a prospective observational study

Alexander Kaltenborn,Sebastian Hoffmann,André Gutcke,Mike Rüttermann,Andreas Settje,Peter M Vogt

doi:10.1186/s12891-017-1414-7

Alexander Kaltenborn, Sebastian Hoffmann + Show 4 more

Open Access

https://doi.org/10.1186/s12891-017-1414-7

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Abstract

BackgroundScapholunate dissociation is the most common form of carpal instability. However, there is no gold standard for operative treatment. In this prospective observational study on 54 patients, a modified minimally invasive dynamic extensor carpi radialis longus tenodesis is described, which is characterized by a smaller approach and application of a cannulated screw and washer for tendon fixation.MethodsQuick-Disabilities of Arm, Shoulder and Hand (DASH)-questionnaire results, post-operative satisfaction, range of motion and grip strength are analyzed.ResultsA median Quick-DASH of 54.6 was observed pre-operatively which significantly improved to a median of 28.4 after the procedure (p < 0.001). Median follow-up was 24 months. Of 46 completely followed-up patients, 31 patients (67.4%) reported that they were satisfied with the outcome. Thirty-seven patients (80.4%) would recommend the procedure to a friend. Thirty-five patients (76.1%) reported some kind of complaint in the operated hand during follow-up. There was no association of severity of symptoms and co-morbidities with the outcome. Neither palmar flexion, nor dorsal extension was significantly different between the operated and non-operated wrist. The operated wrists were observed to have less grip strength than non-operated wrists.ConclusionsThe presented method seems to be as successful as other techniques described in literature. It is less invasive, thus more patient friendly without harming feasibility of future salvage options. However, post-operative complaint rate was quite high.

Highlights

Scapholunate dissociation (SLD) is the most common form of carpal instability
Several operative techniques have been reported for SLD management, the therapeutic method of choice depends on the stage of carpal instability, the status of surrounding joints and the patients’, as well as local preferences [6]
Reported results are ambiguous and the optimal method of choice is still a matter of controversy. In this prospective-observational study, a modified, minimally invasive dynamic extensor carpi radialis longus (ECRL)-tenodesis for treatment of SLD is described, which is a modification based on a technique presented by Bleuler and colleagues in 2008 [9]. Patients and methods This prospective, observational, single-center study included 54 patients, who underwent operative treatment for symptomatic SLD with a modified, minimally invasive ECRL-tenodesis technique, which was based on the dynamic ECRL-tenodesis first described by Bleuler and colleagues [9]

Summary

Introduction

Scapholunate dissociation (SLD) is the most common form of carpal instability. It is a result of a partial or complete rupture of the scapholunate ligament [1]. Several operative techniques have been reported for SLD management, the therapeutic method of choice depends on the stage of carpal instability, the status of surrounding joints and the patients’, as well as local preferences [6]. There is no gold standard for operative treatment. In this prospective observational study on 54 patients, a modified minimally invasive dynamic extensor carpi radialis longus tenodesis is described, which is characterized by a smaller approach and application of a cannulated screw and washer for tendon fixation

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