Scapholunate Ligament Reconstruction With a Novel Technique for Passing Split Extensor Carpi Radialis Brevis Tendon Graft Through Bone Tunnels.

Abstract

We report 2 patients with acute scapholunate dissociation with static instability and wide scapholunate gapping. They underwent scapholunate reconstruction using a split extensor carpi radialis brevis (ECRB) tendon graft via a dorsal approach. This technique is adapted from the modified Brunelli tenodesis, utilizing a portion of the ECRB instead of a flexor carpi radialis tendon graft to reconstruct the scapholunate interosseous ligaments and dorsoradiotriquetral ligaments. The novel aspects of this technique include the use of a trifold plastic sheet of biaxially oriented polypropylene to facilitate the smooth passage of the 2 mm size ECRB tendon graft through the 2 mm bone tunnel. This enables us to avoid drilling larger holes in carpal bones with a relatively poor vascular supply and allows this technique to be utilized in patients with more delicately sized scaphoid and lunate bones. A 2 mm drill bit was used to create the scaphoid and lunate tunnels, which is smaller than that in the published literature. This trifold biaxially oriented polypropylene plastic sheath can be adapted to the use of many other techniques that require passing a tendon graft through a bone tunnel.