Wrist arthroscopy and MRI for the evaluation of scapholunate and lunotriquetral ligaments tear in Kienbock’s disease

Abstract

Purpose The principal intrinsic wrist interosseous ligaments of the wrist are the scapholunate ligament (SLL) and the lunotriquetral ligament (LTL). Injuries to the wrist ligaments are common and can lead to chronic wrist pain. To our knowledge, the incidence of associated intrinsic wrist ligament pathology in Kienbock’s disease has not been previously described. Herein, we used wrist arthroscopy and MRI for the evaluation of SLL and LTL injury in 40 patients with Kienbock’s disease. Patient and methods The study was based on 40 patients with Kienbock’s disease (stages II, IIIa, and IIIb), 17 women and 23 men. Their age ranged from 13 to 46 years (mean, 31 years and 6 months). All patients underwent MRI followed by wrist arthroscopy for the diagnosis of SLL and/or LTL tear. Results The incidence of isolated SLL tear and combined SLL and LTL tear of the 40 patients with Kienbock’s disease included in this study was 27.5 and 7.5% as evaluated with MRI, respectively, and 35 and 15% as evaluated with wrist arthroscopy, respectively. According to Geissler arthroscopic classification, 75% of SLL injury were of grade I, while 25% were of grade III. Moreover, 50% of the patients with ligamentous injury reported a history of trauma with a mean of 4.4 months interval between the trauma and first presentation. Conclusion This study had proved that Kienbock’s disease is associated with tear of SLL and/or LTL in a significant number of patients among the study group. However, it was difficult to distinguish between the degenerative and traumatic ligament tears.