Dorsal Capsulodesis Research Articles

Surgical Techniques in Non-Traumatic Midcarpal Instability: Evaluating the Dorsal Capsulodesis and Three-Ligament Tenodesis Technique.

Surgical management of midcarpal instability (MCI), also referred to as carpal instability nondissociative, remains controversial due to limited evidence on different techniques. This study aimed to assess and compare differences in patient-reported pain, hand and wrist function, patient satisfaction, range of motion, and return to work in patients with non-traumatic MCI who underwent surgical treatment either through dorsal wrist capsulodesis or three-ligament tenodesis (3LT). Patients with MCI and persisting complaints after conservative therapy treated with 3LT or dorsal capsulodesis were included. Patients with posttraumatic instability were excluded. Primary endpoints included the Patient Rated Wrist Evaluation (PRWE) and Satisfaction with Treatment Result Questionnaire at 12 months postoperative. All data were retrospectively analyzed. A total of 91 patients treated with dorsal capsulodesis and 21 treated with 3LT between December 2011 and December 2019 were included. At twelve months postoperative, both treatment groups reported significant improvements in pain and function scores. However, at three months postoperative, the dorsal capsulodesis group exhibited significantly better outcomes, followed by a greater return to work (72%) compared to the 3LT group (50%). However, the capsulodesis group demonstrated a decreased range of motion at three months which was restored at 12 months postoperative. No significant difference in satisfaction with treatment was observed. Both 3LT and dorsal capsulodesis demonstrate promising results for addressing non-traumatic MCI. However, considering the quicker recovery and faster return to work associated with dorsal capsulodesis, we recommend favoring capsulodesis over 3LT when both surgical options are deemed suitable for the patient. III.

Arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor in acute and subacute scapholunate dissociation

PurposeThe objective of this study was to investigate the potential of arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor as a treatment option for patients experiencing symptomatic acute and subacute (< 3 months) scapholunate instability.MethodsFrom Jan. 2017 to Jan 2020, 19 wrists with acute or subacute tears of the SL ligament with symptomatic instability were treated with arthroscopic SL repair and dorsal capsulodesis with a suture anchor. The average time from injury to operation was 8.8 weeks (range, 4–11 weeks) and the regular follow-up mean duration at our clinic was 26.5 months (range, 24–32 months). The pain score according to the visual analog scale, wrist range of motion, grip strength, radiographic outcomes and functional outcomes according to the Modified Mayo Wrist Score (MMWS) were evaluated preoperatively and postoperatively during the follow-up period.ResultsAll 19 patients had rupture and dissociation of the SL ligament in the radiocarpal joint. The total arc of wrist motion in the flexion–extension plane loss averaged 5.1° (P > .01).The Wilcoxon signed-rank test was used to compare the results: grip force improved significantly with 14.7% improvement of that on the normal side (P < .01); the postoperative MMWS was significantly better than the preoperative scores (P < .01). Of 19 patients of the series, 18 patients (94.7%) achieved good or excellent results according to the MMWS and 16 patients (84.2%) resumed their previous activities. Only one patient (5.3%) had residual laxity of the scapholunate ligament joint at 15 months of follow-up.ConclusionsAt a minimum of two years of follow-up, patients with acute or subacute symptomatic dissociation of scapholunate ligament instability who underwent arthroscopic scapholunate ligament repair and dorsal capsulodesis with suture anchor treatment had satisfactory results.Level of EvidenceLevel IV, case series.

Knotless Arthroscopic Dorsal Scapholunate Capsulodesis: A Simplified Technique

Abstract Background Partial dorsal tears of the scapholunate ligament are a common soft-tissue injury in the wrist. These injuries have been a challenging problem and have gone through evolutionary changes over time from different open to arthroscopic techniques. Objectives This study describes a knotless arthroscopic dorsal scapholunate (SL) capsulodesis technique using both the radiocarpal and midcarpal joint portals, indicated for acute or chronic reducible scapholunate instability. Methods Using arthroscopy, we pierce the dorsal capsule on both sides of the dorsal torn remains of the SL ligament with two 18-gauge needles, one loaded with a 2–0 suture and the other with a nitinol wire loop. The 2–0 suture is weaved through the nitinol loop to create a knotless mattress stitch within the midcarpal joint and reduce the torn SL ligament. Results In this article, we present the outcomes of a patient treated with this arthroscopic inside knotless technique in treating scapholunate instability. Conclusions This knotless arthroscopic scapholunate capsulodesis technique provides a simple method to performing an arthroscopic dorsal capsulodesis.

Radiologic Evolution after Scapholunate Dorsal Capsulodesis for Chronic Tears.

Background Many debates are still ongoing for the management of chronic scapholunate (SL) injuries. We have proposed an arthroscopic technique of dorsal capsulodesis with good clinical results. We now propose a radiological follow-up. Purpose To determine if arthroscopic dorsal capsulodesis can improve the radiographic SL angle and maintain this correction over time. Methods From January 2020 to January 2021, we included every patient with an SL instability and sorted them according to the European Wrist Arthroscopy Society (EWAS) classification. All patients had bilateral X-rays with a measurement of the radiolunate (RL) and SL angles for both the pathologic and healthy side. We also included patients with lunotriquetral or triangular fibrocartilage complex lesions. The exclusion criteria were the presence of arthritis and persistent intraoperative SL instability after capsulodesis. An arthroscopic dorsal capsulodesis was performed in all patients as originally described by Mathoulin. The RL and SL angles were then again measured on the immediate postoperative X-ray, and then again at 3, 6, and 12 months postoperatively. The statistical analysis was done using a paired Student's t -test with 145 degrees of freedom and α = 0.05. Results We included a total of 146 patients with a 1-year follow-up. Both the RL angle and the SL angles approach the healthy side at 12 months postoperatively. The RL angle has increased from -7.23 degrees to 4.37 degrees; the difference is still statistically significative, but it is almost equal to the healthy side (5.16 degrees). The SL angle has lowered from 74.55 to 54.95; the difference is still statistically and radiologically significative (6.788 degrees) but has been lowered by 74.3%. Conclusion This study shows that this technique can normalize the dorsal intercalated segment instability (DISI) over time without the need for any pinning or invasive ligament reconstructive surgery. Level of Evidence Level IV, cohort study. Clinical Relevance Dorsal capsulodesis should be considered in all reducible SL injuries, even when DISI is present.

Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases.

Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively. Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity. Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists. Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation. Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion. Level of Evidence Level IV, Case series.

Double Dorsal Capsulodesis in the Treatment of Chronic Scapholunate Instability: Description of a New Surgical Technique and Case Report

Introduction: The scapholunate ligament (SLL) injury can cause wrist pain and instability. There is a wide variety of surgical techniques used for the treatment of this lesion, such as dorsal capsulodeses, tenodeses with flexor or extensor tendons, and bone-ligament-bone graft.&#x0D; Objective: To describe a new technique for the treatment of SLL injury aiming to stabilize the dissociated carpus with a double dorsal capsulodesis.&#x0D; Materials and methods: By presenting the case of a 36-year-old male security officer who injured his left wrist in a motorcycle accident, a procedure to align the carpus is proposed. The long-term outcome of this procedure is also described&#x0D; Results: The proposed surgery was successfully performed; it had excellent clinical and functional results, with no complications. Long-term restoration of carpal alignment observed in wrist radiographs was evidenced after two years of follow-up, the patient was asymptomatic and with full functional recovery.&#x0D; Conclusion: The proposed technique appears to be reproducible, effective and easy to perform. Unlike the technique described by Blatt, the aim of this one is to restore the physiological position of the lunate bone by adding a second capsulodesis, as it is believed to be an essential factor in the maintenance of carpal kinematics.

Dorsal Wrist Ganglia: Influence of Arthroscopic Dorsal Capsulodesis – A Pilot Study

Abstract Background Dorsal wrist ganglia are the commonest soft tissue tumor in the upper extremity. Management with arthroscopic excision yields good results and few complications, but recurrence is still a matter of concern. Purpose To address the influence of dorsal capsulodesis in postoperative results. Patients and Methods Two groups with eight patients each were evaluated: group A – simple arthroscopic resection (SAR), and group B – arthroscopic resection combined with dorsal capsulodesis (ARDC). Results The mean age of group A was of 36.10 ± 7.96 (range: 28–53) years, and that of group B was of 34.17 ± 29.60 (range 18–44) years. The duration of the follow-up was of 30.67 ± 13.90 (range: 13.45–53.55) months and 29.60 ± 16.80 (range 12.68–62.13) months, respectively. Both groups achieved a a significant decrease in the postoperative score on the Visual Analog Scale (VAS) (of around 2/10), and the scores on the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were below 5/100. All the functional parameters (range of motion and strength) were above 80% on the contralateral side, with no differences between groups. More than 75% of the patients were completely satisfied. Group A (37.5%) had a significantly higher recurrence rate than that of group B (12.5%). Conclusions In conclusion, SAR and ARDC provided good clinical results, with no significant differences. Dorsal capsulodesis resulted in an important decrease in the recurrence rate. Level of Evidence Level III (Retrospective Comparative Study).

Preoperative and Postoperative Imaging of Scapholunate Ligament Primary Repair and Modified Brunelli Reconstruction.

Injury of the scapholunate ligament (SLL) complex can lead to scapholunate dissociation, characterized by scapholunate interval widening and volar rotary subluxation of the scaphoid. Loss of the mechanical linkage between the scaphoid and lunate results in carpal instability and eventual scapholunate advanced collapse (SLAC) arthropathy. SLL complex injuries vary from acute and traumatic to chronic and degenerative. A staging system can be used to guide treatment options for these injuries on the basis of the reparability of the SLL dorsal band, carpal alignment and malalignment reducibility, and cartilage damage. Preoperative imaging with radiography and MRI is a component of injury staging and aids in planning surgical procedures. If the SLL dorsal band is reparable, then direct primary ligament repair with dorsal capsulodesis or dorsal intercarpal (DIC) ligament transfer can be performed. If the SLL dorsal band is irreparable with normal alignment or reducible malalignment, then reconstruction can be performed. In the setting of irreducible malalignment or SLAC arthropathy, a salvage procedure can be performed. Knowledge of SLL primary repair and various reconstruction techniques is important not only when evaluating postoperative images but also for accurate description of SLL injuries and aiding the surgeon in treatment planning. The authors present the normal anatomy of the SLL complex, a staging classification of SLL injury with radiographic and MRI findings, and common surgical procedures. Special attention is given to the operative techniques and postoperative imaging appearances of primary SLL repair with DIC ligament transfer and modified Brunelli reconstruction. ©RSNA, 2021.

Outcomes of Acute Versus Subacute Scapholunate Ligament Repair

PurposeThis study investigated the long-term outcomes of direct scapholunate ligament (SLL) repairs with or without dorsal capsulodesis performed within 6 weeks (acute repair) of a SLL tear versus 6 to 12 weeks following injury (subacute repair).MethodsA review of medical records from April 1996 to April 2012 identified 24 patients who underwent SLL repair (12 acute, 12 subacute). Patients returned to the clinic for radiographic examinations of the injured wrist, standardized physical examinations, and validated questionnaires.ResultsThe mean follow-up times for the acute and subacute groups were 7.2 and 6.2 years, respectively. At the final examination, patients with acute surgery regained more wrist extension (acute = 55°, subacute = 47°). The total wrist flexion-extension arcs, grip strengths, pinch strengths, and patient-rated outcome scores were found to be similar between groups. The final scapholunate gap, scapholunate angle, and the prevalence of arthritis were also found to be similar between the acute and subacute groups.ConclusionsAlthough SLL repair is more commonly recommended for treatment of acute SLL injuries, there were no significant long-term differences between acute and subacute SLL surgeries (repair ± capsulodesis).Type of study/level of evidencePrognostic III.

Arthroscopic dorsal capsulodesis for isolated lunotriquetral interosseous ligament injuries.

We assessed the outcomes of isolated lunotriquetral ligament injuries in ten patients who underwent arthroscopic dorsal capsulodesis. Data from patient records, radiologic images and arthroscopic video records were evaluated. The patients were evaluated for ulnar-sided wrist pain with history and physical examination. Preoperative radiographs and MRIs for pain aetiology were assessed. The patients underwent arthroscopic dorsal capsulodesis and were evaluated 29months (range 19-45) after surgery. Nine patients returned to their original jobs. In one patient pain was aggravated with heavy activities. Mean scapholunate angle was 44°. There were significant improvements postoperatively in pinch and grip strength and MAYO wrist, patient-reported wrist evaluation and pain scores. The wrist flexion-extension and the radial ulnar deviation were significantly improved compared with the contralateral hand. We conclude that arthroscopic dorsal capsulodesis offers effective management for isolated lunotriquetral interosseous ligament injuries.Level of evidence: IV.

Short-term Results of Arthroscopic Dorsal Capsulodesis in Scapholunate Instability

Short-term Results of Arthroscopic Dorsal Capsulodesis in Scapholunate Instability

Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results.

Objective To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained. Methods The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded. Results Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results Conclusion The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

Dorsal Intercarpal Ligament Preserving Arthrotomy and Capsulodesis for Scapholunate Dissociation

Carpal instability secondary to scapholunate (SL) ligament tears can lead to a significant disability of the wrist. Different surgical procedures have been proposed to treat SL instability. A variety of dorsal capsulodesis techniques tethering the scaphoid have been used in patients with SL dissociation. We report a novel technique of modified dorsal intercarpal ligament (DICL) capsulodesis for the treatment of SL dissociation. The surgical indication for this procedure is complete SL ligament tear with a reducible carpal malalignment and no secondary osteoarthritis. This procedure is indicated when the remnant of torn ligament in the dorsal SL interosseous space is available for repair. First, carpal malalignment is corrected and the scaphoid and the lunate are temporarily fixed with a transosseous screw or Kirschner wires. Using a dorsal approach, the DICL is then exposed, which originates from the triquetrum and attaches to the scaphoid, trapezium, and trapezoid. The distal and proximal borders of the ligament are identified and elevated without detaching the attachment sites. The DICL is transferred proximally to reinforce the dorsal SL interosseous ligament. The wrist joint is immobilized for 3 weeks postoperatively, and dart-throwing motion is permitted until temporary SL fixation is removed at 2 to 3 months after surgery. A wrist brace is recommended until 3 to 6 months after the first surgery depending on the patient's occupation and sports activity.

Arthroscopic scapholunate dorsal capsulodesis: A 30-patient case series comparing postoperative splint immobilization versus immobilization and connected K-wiring

The aim of this retrospective study was to compare the results of arthroscopic dorsal capsulodesis performed with or without temporary K-wiring to treat patients who had sustained scapholunate ligament injuries. Our case series included 30 patients with an average age of 37 years (range: 19–55) of whom 12 were female. Dorsal scapholunate capsulodesis was carried out in all patients. In 15 patients, splint immobilization only was used (group I). For the remaining 15 patients, supplementary scapholunate and scaphocapitate K-wiring was performed (group II). The outcomes, whether K-wiring was used or not, were not as good as the outcomes of other published studies. In our study, the reported QuickDASH score was on average higher than 20/100, pain score was higher than 2/10, grip strength was less than 70% of the contralateral side. There was one postoperative complication in the first group and three complications in the second group; five cases of DISI were reported in the first group and three in the second group. There were no significant differences between the two groups. Based on our findings, supplementary K-wiring is not necessary when a dorsal scapholunate capsulodesis is performed. The outcomes of our study were not as good as those of other published series, potentially due to a shorter follow-up and the more severe ligament injuries in our case series.

Dorsal capsulodesis associated with arthoscopy-assisted scapholunate ligament reconstruction using a palmaris longus tendon graft

ObjectivesTo measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. MethodsFrom January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analog scale (VAS), and radiographic analysis to visualize the pre- and postoperative SL gap and the pre- and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. ResultsThe follow-up time was 12 months (3–17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1–6). DASH was 6.50/100 (1–30). The time to work return work was 4.42 months (2–17). As for complications, one patient developed SLAC, and underwent four-corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities.The preoperative SL gap was 4.29mm (2–7); in the postoperative period, it was 1.79mm (1–4). The DISI deformity was present in ten patients with SL angle>70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. ConclusionThe new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

Update on operative treatment of scapholunate (SL) instability for radiologists: part 1-SL ligament repair, dorsal capsulodesis and SL ligament reconstruction.

Scapholunate instability is the most common form of carpal instability. Imaging (especially radiography) plays an important role in the staging, management and post-operative follow-up of scapholunate (SL) instability. The goals of this article are to review the pre-operative staging of SL instability, the surgical options for repair and reconstruction of the SL ligament, along with the normal postoperative imaging findings as well as complications associated with these surgical options.

Capsulodese dorsal associada à reconstrução assistida por artroscopia do ligamento escafossemilunar com enxerto do tendão do músculo palmar longo

ObjectivesTo measure the quality of life, the time to work return, and clinical, functional, and radiographic parameters of patients treated with dorsal capsulodesis associated with scapholunate (SL) reconstruction, assisted by arthroscopy. MethodsFrom January 2015 to September 2016, 14 adult patients with SL dissociation underwent surgical treatment with the SL reconstruction procedure assisted by arthroscopy, using the new technique proposed in this study. All patients were assessed by the occupational therapy department at regular intervals after surgery and performed the same sequence of rehabilitation. The parameters analyzed were: range of motion (ROM), Disability of the Arm, Shoulder, and Hand (DASH), visual analogue scale (VAS), and radiographic analysis to visualize the pre‐ and postoperative SL gap and the pre‐ and postoperative dorsal intercalated segment instability (DISI) deformity the. The complications and the time to return to work activities were described. ResultsThe follow‐up time was 12 months (3–17). The ROM averaged 321° (96.9% of the normal side). VAS was 1.79/10 (1–6). DASH was 6.50/100 (1–30). The time to work return work was 4.42 months (2–17). As for complications, one patient developed SLAC, and underwent four‐corner fusion one year after ligament reconstruction. Currently, he has experienced pain relief, with a functional range of motion of the wrist, and has not yet returned to professional activities.The preoperative SL gap was 4.29mm (2–7); in the postoperative period, it was 1.79mm (1–4). The DISI deformity was present in ten patients with SL angle>70° (preoperative) and it was corrected after surgery, in all patients. SLAC stage I was identified in a patient. Arthroscopy was performed in all cases. The SL instability was classified as Geissler grade III in four cases and as grade IV in ten cases. ConclusionThe new approach (dorsal capsulodesis associated with SL reconstruction, assisted by arthroscopy) presented in this study is safe and effective in the treatment of SL dissociation, since it offers satisfactory clinical, radiographic and functional results, showing low rates of complications. For patients, it allows the return to their social and professional activities, and increases their life quality.

Neglected isolated scaphoid dislocation.

The authors present a case of isolated scaphoid dislocation in a 40-year-old male that was undiagnosed for 2 months. The patient was treated by open reduction, Kirschner wire fixation, interosseous ligament repair using a suture anchor and Blatt's dorsal capsulodesis. At 6 years followup, his radiographs of wrist showed a normal carpal alignment with a scapholunate gap of 3 mm and no evidence of avascular necrosis (AVN) of the scaphoid.

Identification et traitement les lesions intra-carpiennes

High energy injuries of the wrist may cause perilunate dislocations and fracture-dislocations that may develop in a spectrum of injuries of different severity affecting bone and ligaments, or ligaments alone even without dislocation (PLIND injuries). The use of arthroscopic assistance in treating wrist trauma has allowed the finding of association between bone and intracarpal ligament injuries in high percentage of cases. The aim of this study is to evaluate the results of treatment of multiple intracarpal ligament injuries with without simultaneous internal fixation of carpal bones. Twelve patients were treated since 2008. Of those, eight patients affected by simultaneous scaphoid fracture and SL ligament lesions and four patients with associated scapholunate (SL) and lunotriquetral (LT) ligaments. All were males and the mean age was 34 years old (21–65). All patients were examined under arthroscopy and lesions classified according to Geissler and EWAS Classifications. The scaphoid fractures were treated by screw fixation with or without a graft and the ligaments injuries by capsulodesis open or arthroscopic. The patients were evaluated at a mean follow-up of 11 months (5 months–8 years). The Mayo and DASH scores were used for evaluation at follow-up. Scapho-lunate injuries were Geissler stage III in 8 patients (EWAS IIIC 6 cases, IIIB 2 cases, IIIA 1 case) and a Geissler EWAS stage II in 3 patient. At follow-up, X-rays documented healing of the fracture in all cases. The results were excellent and good according to the Mayo Wrist Score. Grip strength was comparable to contralateral side and patients returned to previous work. One patient reported occasional pain under load at follow-up at 5 months. Two patients treated with dorsal capsulodesis had a slight reduction of flexion. The diagnosis of ligamentous lesions has been evolving in the last years with the diffusion of wrist arthroscopy that allows their direct identification. Nowadays, we know that a spectrum of different ligament lesions can occur and that they can be associated in different ways, still under definition. Our preliminary results are excellent and good and a longer follow-up is needed to correctly evaluate the results in the long term. The increased use of arthroscopic examination of the wrist is advisable in wrist trauma in order to establish a correct diagnosis, prognosis and treatment of all the patient's lesions, possibly preventing degenerative arthritis.

Arthroscopic transosseous modified Mathoulin dorsal scapholunate capsulodesis – feasibility study and preliminary series of 10 patients

Objective There is no common trend concerning arthroscopic repair for chronic scapholunate ligament tears, especially when no remnant ligament subsists. The aim of this study was to assess the feasibility of an arthroscopic transosseous dorsal scapholunate capsulodesis. Material and method Our series consisted of 10 patients presenting scapholunate tears EWAS stage IIIC for 8 patients and EWAS stage IV for 2 patients. Arthroscopic portals (MCU, MCR, 1–2 and 6R) and an 1 cm 3–4 portal with no capsulotomy were used. After arthroscopic debridement of the scapholunate area two 1 mm k-wires were passed through 3–4 portal into scaphoid and lunate. Two tunnels were performed using 2.4 mm canulated drills guided by the k-wires under arthroscopic control. A fiberwire was passed through those 2 tunnels and was knotted tight on the dorsal capsule. At the end of the procedure wrist was casted in light extension for 6 weeks. Rehabilitation started at the end of this period. Results At the latest follow-up (mean 8 months) we noticed significant pain relief, significant qDASH improvement and better grip strength for 8 patients. One developed a regional complex pain syndrome. Radiologically, there were no fractures and no scaphoid or lunate osteonecrosis. Conclusions Despite the weaknesses of our preliminary series with short follow-up and only few patients our results showed a significant clinical improvement. Nevertheless, the results should be confirmed with a bigger comparative series and a longer follow-up especially for the assessment of late osteoarthritis.