Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft

Abstract

This study was designed to evaluate the use of a locally available bone-retinaculum-bone graft in the reconstruction of the completely torn scapholunate (SL) ligament. Nineteen consecutive patients (14 with dynamic instability and 5 with static instability) underwent SL ligament reconstruction using an autogenous bone-retinaculum-bone graft taken from the third dorsal compartment region. All patients underwent arthroscopy to document a torn SL ligament. The bone plugs on the graft were fitted into the dorsal scaphoid and lunate, respectively, with the retinaculum periosteal soft tissue intervening sleeve arching between these 2 bones. The SL interval was reduced and pinned for 8 weeks with cast immobilization. The follow-up period averaged 3.6 years (minimum, 24 months). Of the 14 patients with dynamic instability, 12 had no pain and 2 had pain with heavy activity of the wrist. Range of motion (ROM) decreased slightly from preoperative values, and grip strength improved 46%. Thirteen patients were completely satisfied and returned to their former work activities, and 1 returned to modified work activities. Of the 5 patients with static instability, 2 had no pain after surgery, 1 had pain with heavy activity, and 2 had constant pain. ROM in this group decreased moderately in extension/flexion from the preoperative values. Grip strength improved 30% from preoperative values. Satisfaction was rated as complete by 1 patient and partial by 2 patients; 2 patients were dissatisfied. Two patients returned to their former jobs, 2 returned to modified duties, and 1 is on disability. Reconstruction of the SL ligament using a bone-retinaculum-bone autograft is predictable in patients with dynamic instability. Use of this technique with static SL instability is questionable; these patients may require a stronger construct to prevent recurrence of the SL gap.