Scapholunate Research Articles

The Use of Cone-Beam Computed Tomography (CBCT) Arthrography for Wrist Ligamentous Injuries - A Diagnostic Test Accuracy Meta-analysis.

Background: Diagnosis of ligamentous wrist injuries can be challenging with the absence of dynamic instability on radiographs. Our aim was to evaluate the accuracy of cone-beam computed tomography (CBCT) arthrography in diagnosing scapholunate ligament (SLL), lunotriquetral ligament (LTL) and triangular fibrocartilage complex (TFCC) injuries. Methods: A systematic review and literature search were conducted in compliance with Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) and registered at the International Prospective Register of Systematic Reviews, PROSPERO (CRD42024517655). A mixed-effects logistic regression bivariate model was used to estimate summary sensitivity and specificity, and hierarchical summary receiver operating characteristic (HSROC) curves were constructed to determine diagnostic accuracy of CBCT arthrography. Results: We identified five studies assessing the accuracy of CBCT arthrography against wrist arthrography or intraoperative findings as reference standard. The pooled estimates for sensitivity and specificity of CBCT arthrography was 93% (95% CI 40-100) and 91% (95% CI 81-96) for SLL injuries, 83% (95% CI 37-98) and 64% (95% CI 42-81) for LTL injuries and 78% (95% CI 57-91) and 80% (95% CI 54-93) for TFCC injuries. The area under the curve was 0.91 (95% CI 0.89-0.94), showing an excellent diagnostic accuracy of CBCT arthrography in SLL injuries. CBCT arthrography had an estimated mean effective dose of 3.2 mSv (2.0-4.8). Conclusions: Our study confirms that CBCT arthrography has an excellent diagnostic accuracy for wrist ligamentous injuries with comparably high sensitivity to conventional arthrography and a better specificity. While further studies with more robust methodology are required to support its implementation in clinical practice, our analysis shows that it is a reliable option and has a promising future. Level of Evidence: Level III (Diagnostic).

Radiolunate Fusion After Pyogenic Arthritis Caused by Pinning for Scapholunate Dissociation

Radiolunate Fusion After Pyogenic Arthritis Caused by Pinning for Scapholunate Dissociation

Wrist & Hand

The October 2024 Wrist & Hand Roundup360 looks at: Circumferential casting versus plaster splinting in preventing redisplacement of distal radial fractures; Comparable outcomes for operative versus nonoperative treatment of scapholunate ligament injuries in distal radius fractures; Perceived pain during the reduction of Colles fracture without anaesthesia; Diagnostic delays and physician training are key to reducing scaphoid fracture nonunion; Necrotizing fasciitis originating in the hand: a systematic review and meta-analysis; Study design influences outcomes in distal radial fracture research; Long-term results of index finger pollicization for congenital thumb anomalies: a systematic review; Enhancing nerve injury diagnosis: the evolving role of imaging and electrodiagnostic tools.

Arthroscopic Dorsal Round-Block Capsulo-Ligamentoplasty for Dynamic Scapholunate Instability: An Anatomical Study and Case Series

Abstract Background Chronic dynamic scapholunate (SL) instability remains difficult to treat. Several treatment options exist. Purpose We propose an arthroscopic dorsal round-block capsulo-ligamentoplasty technique to treat dynamic scapholunate instability: a dorsal purse-string-like suture around the dorsal aspect of the proximal row, following the course of the dorsal intercarpal ligament (DICL). A Fiberwire suture travels between the radiocarpal and midcarpal space, piercing the attachments of the DICL on the triquetrum and of the scaphotrapezial ligament on the distal scaphoid. It reinforces the DICL and the dorso-capsuloscapholunate septum, also inducing a fibrotic healing. Moreover, it produces an extension lever correcting the scaphoid flexion/pronation. Compared with other capsulodesis techniques, the all-inside dorsal round-block capsulo-ligamentoplasty is theoretically likely to produce less stiffness, without additional damage to the SL complex. The wrist remains practically undamaged after surgery: no bone tunnels, bone anchors, or tendon grafts are required, thus enabling all possible secondary procedures. Data of a cadaveric study and case series illustrate the technique. Conclusion The arthroscopic dorsal round-block capsulo-ligamentoplasty can be considered to treat chronic dynamic scapholunate instability.

Dynamic CT features of scapholunate instability during the wrist extension to flexion-An in vivo study

PurposeThis biomechanical study aimed to assess the change in the radioscaphoid and the radiolunate angles during wrist extension to flexion in scapholunate instability compared to the healthy wrist. MethodsDynamic CT scans of 19 participants with no history of wrist pathology and 19 patients with scapholunate instability without degenerative changes were selected. Motion sequence studied was wrist extension to flexion. Image segmentation followed by 3D registration techniques were used to calculate the displacement field between scaphoid and lunate models in each time point. The radiocarpal angles and centroid positions were computed in the neutral wrist and throughout wrist motion. Comparisons were made between the normal and the scapholunate instability wrists. ResultsThe scapholunate instability wrist had less range of extension to flexion compared to the normal wrist. The scapholunate instability scaphoid was flexed and internally rotated in the neutral wrist position and throughout the range of motion. The scapholunate instability scaphoid centroid remained radial and distal in the extended wrist. The scapholunate instability lunate was significantly extended from wrist 20° extension to 50° flexion. The scapholunate instability lunate centroid was more ulnar from 70° wrist extension to 50° flexion. ConclusionsThe scapholunate instability scaphoid demonstrated rotational abnormalities in two planes throughout the wrist motion and abnormal centroid positions in the extended wrist. The lunate extension in scapholunate instability was significant mostly during wrist flexion. Radioscaphoid instability appear to be the primary pathology in SLI and can be used to differentiate the SLI wrist from the normal throughout wrist extension to flexion. Lunate extension is not different between the normal and scapholunate instability in the extended wrist. Level of evidenceLevel III.

Clinical, radiological and dynamic CT results of scapholunate intercarpal ligamentoplasty for scapholunate dissociation

A clinical, radiological and four-dimensional computed tomography (4DCT) assessment of the outcomes of scapholunate intercarpal ligamentoplasty (SLICL) was done with a minimum follow-up of 2 years. Twenty-nine patients (23 men and 6 women) with a mean age of 40 years (22–57) who had chronic scapholunate dissociation were treated with the SLICL procedure. There were 18 cases of dynamic instability and 11 of static instability. The patients were evaluated with a mean follow-up of 61 months (24–94). SLICL significantly reduced pain and increased grip strength and wrist function. On radiographs, the mean static and dynamic scapholunate gaps as well as the scapholunate and radiolunate angles improved significantly. The dorsal scaphoid displacement was always corrected. 4DCT after surgery provided a more precise analysis of the SLICL’s effectiveness at restoring intracarpal alignment. Correction of the DISI deformity and dorsal scaphoid displacement was confirmed. SLICL restored a normal variation in the scapholunate gap (range value) during radioulnar deviation movement without systematically reducing the distance between the bones (mean and maximum values) which remained pathological in wrists with static instability but not in those with dynamic instability. At the final follow-up, no patients had signs of osteoarthritis due to ScaphoLunate Advanced Collapse. Level of evidenceIII.

Mapping wrist motion: 3D CT analysis after scapholunate ligament transection.

The injury of the scapholunate (SL) ligament is common in wrist traumas leading to pain and reduced wrist function. The wrist's unique joint design and possible underlying theories as the carpal row theory were subject to earlier investigations studying wrist kinematics. Nevertheless, a comprehensive understanding of how SL ligament injuries affect wrist biomechanics is still lacking. Through a quantitative analysis of carpal bone motion patterns, we evaluated the impact on wrist kinematics occurring after SL ligament injury. We conducted a study using computer tomography imaging to analyse wrist kinematics after SL ligament transection in 21 fresh-frozen anatomical specimens. The collected data were then transformed into 3D models, employing both standardized global and object coordinate systems. The study encompassed the evaluation of rotation and translation for each individual carpal bone, as well as the ulna, and all metacarpal bones in reference to the radius. The study showed a significant increase in rotation towards palmar (p < 0.01), particularly notable for the scaphoid, following transection of the SL ligament during palmar flexion. Ulnar deviation did not significantly affect rotation or translation, and radial deviation also showed no significant changes in rotation or translation. The study highlights the significance of the SL ligament in wrist kinematics, revealing that SL ligament tears lead to changes in wrist motion. While we observed significant rotational changes for the scaphoid, other carpal bones showed less pronounced alterations, emphasizing the complexity of wrist biomechanics.

Catch the shift: Ultrasound diagnosis of scapholunate lesion during Watson test

Scapholunate ligament lesion is the most common ligament lesion in the wrist. We assessed the reliability of sonography in detecting it during Watson test. Twenty patients with scapholunate ligament lesion confirmed on MRI and intraoperatively were assessed preoperatively between July 2020 and April 2023. Sonography was performed on the scaphoid dorsal subluxation in wrist neutral and during Watson test and compared with the healthy contralateral side. Dorsal subluxation was measured by two independent investigators and intra- and inter-observer reliability were assessed. We found a significant difference between dorsal subluxation of the scaphoid in the healthy (0.89 mm, SD 0.67 mm) compared to the pathological side (1.67 mm, SD 0.95 mm). Reliability was very good and the standard error of measurement was less than 0.4 mm for all measurements. Sonography during Watson test demonstrated high reliability in diagnosing scapholunate lesions. Level of evidenceIII.

Needle Arthroscopy Versus Conventional Arthroscopy in the Evaluation of Carpal Pathology: A Comparative Study.

The needle scope is a less invasive intervention to evaluate carpal pathology. We hypothesize that there is no difference in the evaluation and diagnostic capability of the needle scope versus the conventional wrist arthroscope. Twenty patients indicated for wrist arthroscopy were prospectively enrolled. Prior to insertion of the 2.7-mm arthroscope, the needle scope evaluated for synovitis; cartilage damage (location and modified Outerbridge classification); integrity of the volar, scapholunate (SL), and lunotriquetral ligaments; and the triangular fibrocartilage complex (TFCC). Following needle scope evaluation, the surgeon completed a survey regarding the visualization and diagnosis. The 2.7-mm arthroscope was then inserted, and the surgeon completed the second portion of the survey. Statistical analysis was then completed to determine statistical significance. Twelve patients were female (60%), and the mean age was 39.8 years (±11.8 years). Eleven patients underwent arthroscopy for TFCC pathology, 4 patients for SL tearing, and 5 patients for extensive synovitis. There was no difference between the needle scope and wrist arthroscopy diagnosis. There was no difference between radiocarpal and midcarpal visualization. Surgeon-rated ease of use and diagnostic confidence were the same between two groups. The needle scope was better able to visualize the scapho-trapezium-trapezoid and carpometacarpal joints; however, the image was of marginally decreased quality. In this study, there was no difference between radiocarpal or midcarpal visualization and surgeon-rated ease of use, while diagnostic confidence was the same between two groups. II (prospective cohort study)-Diagnostic.

Double Trouble: Malunited Distal Radius Fracture and Scapholunate Ligament Injury

Double Trouble: Malunited Distal Radius Fracture and Scapholunate Ligament Injury

Radiopalmar ganglion cysts: prevalence, morphology, and clinical significance in wrist MRI.

To assess radiopalmar ganglion cysts' (RPG) prevalence, morphology, and clinical significance in consecutive patients. In this retrospective single-center study, two radiologists assessed the presence of RPG and morphologic features on wrist MRI. Radiopalmar complaints and scapholunate ligament (SLL) tears were evaluated. A total of 1053 wrists in 909 patients (mean age 43.4 ± 15.5 years, 602 females) were evaluated. All 308 RPG (Group 1; 308 patients, 29.2%) originated from the palmar capsule; 49 were unilocular, 95 oligolocular, and 164 multilocular; 745 wrists had no RPG (Group 2; 601 patients). One hundred and twenty-six RPG showed internal debris. The mean diameter was 8.5 ± 5.6 mm (cranio-caudal) (1.0-32.9 mm), 8.0 ± 4.1 mm (medio-lateral) (1.0-31.9 mm), and 3.7 ± 2.3 mm (dorso-palmar) (0.4-16.0 mm). 168 RPG showed direct contact with the radial vascular bundle, 24 with the flexor carpi radialis tendon, and 123 with the flexor pollicis longus tendon. In Group 1, significantly more patients showed partial (82/308) [group 2: 45/745, p < 0.001] or complete SLL tears (22/308) [group 2: 20/745, p < 0.001]. Of the patients with RPG, 15.3% presented with radiopalmar complaints. Only the dorso-palmar RPG diameter was positively correlated with radiopalmar complaints (for readers 1 and 2: rs = 0.66/0.61, p < 0.001, respectively), and the best dorso-palmar diameter cut-off value for the probability of having radiopalmar complaints was defined at 3 mm (area under the curve (AUC) 0.74). Other morphologic features were not eligible to discriminate symptomatic patients (AUC range 0.53-0.61). This study found RPG in 29% of patients, most of them asymptomatic. However, a dorso-palmar cyst diameter > 3 mm may be clinically significant. Radiopalmar ganglion cysts, observed in 29% of wrist MR examinations, are mostly asymptomatic, but those with a larger dorso-palmar diameter may be associated with radiopalmar complaints. Radiopalmar ganglion cysts are found in 29% of patients undergoing wrist MRI. Most patients with evidence of radiopalmar ganglion cysts do not show radiopalmar symptoms (85%). A dorso-palmar cyst diameter > 3 mm may be associated with radiopalmar complaints.

The Radiographic Effects of Lunotriquetral Coalition on Scapholunate Articulation

Introduction: Radiographic widening in the scapholunate (SL) joint due to lunotriquetral (LT) coalition has historically been viewed as normal due to reported false positives of SL dissociation/widening in patients with LT coalition. Minimal further investigations have been reported on these findings. Methods: Scapholunate interval, angle, third CMC joint space, and ligamentous measurements on CT, MRI, and X-ray imaging were compared for those with and without LT coalition. A multilevel one-way ANOVA was used to analyze CT SL angle versus X-ray SL angle and was compared to the control group. These comparisons were also performed for SL intervals and repeated for MRI imaging versus X-ray imaging. A t-test was completed to compare volar and dorsal ligament widths measured on MRI for the lunotriquetral and normal groups. Results: On X-ray and CT, no difference was measured in SL interval, angle, and third CMC joint space between those with and without LT coalition, but SL angle was higher in those without LT coalition on CT. On MRI, no difference was measured in SL angle, but SL interval was smaller in those without LT coalition. SL interval compared to third CMC joint space was smaller for all cohorts on MRI and CT. Conclusions: X-ray, CT, and MRI imaging of SL interval widening was not seen above normal radiographic parameters in the setting of LT coalition. Therefore, radiographic parameters of SL dissociation/widening should not change with LT coalition. The third CMC joint space was smaller compared to the SL interval and should not alone be used for radiographic diagnosis of SL dissociation.

Medium-Term Patient-Reported Outcomes after Surgical Management of Perilunate Injury: A Multiinstitutional Experience

Abstract Background There is a lack of consensus on the optimal treatment of perilunate injuries (PLIs). Open reduction with internal fixation with scapholunate (SL) ligament repair is recommended; however, procedures such as lunotriquetral (LT) ligament repair, carpal tunnel release (CTR), proximal row carpectomy, denervation, and arthrodesis may also be used. Purpose The purpose of this study was to assess patient-reported outcomes (PROs) after surgical management of PLIs. Methods A retrospective review of surgically treated PLIs at two institutions in a major metropolitan city from 2014 to 2020 was conducted. Demographics, radiographic data, and details of surgical management were reviewed. PROs were prospectively collected and analyzed. Results Eighty-seven patients with surgically managed PLIs were identified. The average time to surgery was 4 ± 7days. Twenty-six percent of patients presented with acute median neuropathy. Thirty-seven patients provided PROs for analysis. Patient-Rated Wrist Evaluation scores were 22 ± 12.9, 14.4 ± 11.3, and 37 ± 22 for pain, function, and total scores, respectively. Satisfaction was 7 ± 3 Sixteen percent of patients were unable to maintain employment due to their injury. The interval to return to work was 6.3 ± 7.7 months. Conclusion PLIs cause significant morbidity and affect patients' ability to return to work. While open reduction with SL repair is routinely performed to treat PLIs, additional procedures may be considered. Undergoing concurrent CTR in the absence of neurological symptoms showed no differences in outcomes. Level of Evidence Level III, retrospective cohort study.

Dorsal wrist ganglion: clinical and imaging correlation in symptomatic population based on high-field MRI

Abstract Objectives To determine prevalence in the symptomatic population of dorsal mucoid cysts centered on dorsal capsuloscapholunate septum (DCSS) using high-field magnetic resonance imaging (MRI) for anatomoclinical and epidemiological correlations. Materials and methods This single-center retrospective study analyzed all 3-Tesla MRIs consecutively performed for painful wrists in 295 patients. Two blinded readers performed measurements. The protocol included T1 spin echo and 3D proton density sequences with fat saturation. Inter-observer reliability was assessed using kappa and intra-class correlation coefficients for cyst detection and volumetry, respectively. Disagreements concerning cyst detection were resolved by a consensus reading. Cyst size, relationship to extrinsic and scapholunate ligaments (SL), continuity of SL, minimum distance to the posterior interosseous nerve (PIN), cyst communication with joint, and anatomical classifications of cysts were analyzed. Correlation tests were performed to assess associations. Results Two-hundred ninety-five patients (mean age 39.6 +/− 15.6 (standard deviation), 161 males) were evaluated for detection of dorsal wrist cysts identified in 150/295. In this subgroup, the mean age was 38.7 years (15–75), the sex ratio of 0.6 (59% women), and the median volume cyst of 8.7 mm3 (0.52–2555). Cyst detection, volume, and major axis measurements showed very high agreement between observers, respectively, 0.89, 0.96, and 0.91. 42 patients had dorsal SL pain. A weak negative correlation was found between distance to PIN and dorsal SL pain (r = −0.2415; p &lt; 0.05) and a weak positive correlation between Guérini’s classification and dorsal SL pain (r = 0.2466; p &lt; 0.05). Conclusion High-field MRI is the modality of choice for the detection, anatomical, and volumetric assessment of dorsal cysts. Preoperative assessment will be aided by the proposed revised anatomical classification. Clinical relevance statement High-field MRI is the modality of choice for the anatomical study of dorsal ganglion cysts. It allows the radiologist to accurately describe the anatomical relationships, size, and visibility of the pedicle, essential information for the surgeon’s preoperative assessment. Key Points Dorsal mucoid wrist ganglion is a condition for which prevalence remains to be determined. High-field MRI is a reproducible imaging modality for the detection and assessment of dorsal wrist cysts. High-field MRI has a key role in the preoperative management of dorsal mucoid cysts.

Post-processing of quantitative 4D-CT for initial evaluation of scapholunate Instability: Assessment of simplified approaches to data analysis

ObjectivesTo evaluate the diagnostic performance of simplified post-processing approaches for quantitative wrist 4D-CT in the assessment of scapholunate instability (SLI). MethodsA prospective monocentric case-control study included 60 patients with suspected post-traumatic scapholunate ligament (SLL) tears and persistent pain. Of these, 40 patients exhibited SLL tears, subdivided into two groups of 20 each: one group with completely torn ligaments and the other with partially torn ligaments. The remaining 20 patients, whose SLLs were intact, served as controls. 4D-CT and CT arthrography were performed, and post-processed by two readers using three approaches: the standard method with full data assessment and dedicated software, partial data assessment with post-processing software (bone locking), and partial data assessment without post-processing software (no bone locking). The scapholunate gap (SLG) parameter was measured in millimeters to evaluate scapholunate diastasis during radioulnar deviation (RUD). The scapholunate ligament status on CT arthrography was considered the gold standard. ResultsThe SLG-derived parameters (range, mean, and maximal values) were significantly increased in patients with both intact and torn scapholunate ligaments across all post-processing approaches (P values ranging from 0.001 to 0.004). SLG range was the best parameter for diagnosing SLL tears, with ROC AUC values ranging from 0.7 to 0.88 across the three post-processing methods. The interobserver reproducibility was better with the alternative approaches (ICC values 0.93–0.96) compared to the standard approach (ICC values 0.65–0.72). Additionally, post-processing time was shorter with the alternative approaches, especially when specific software was not used (reduced from 10 to three minutes). ConclusionSimpler approaches to wrist 4D-CT data analysis yielded acceptable diagnostic performances and improved interobserver reproducibility compared to the standard approach.

Retinaculum Grafts in Scapholunate Ligament Reconstruction: A Systematic Review

Abstract Background Several surgical techniques for the treatment of the irreparable chronic scapholunate (SL) ligament disruption, without arthritis, have been described using tendon grafts. An alternative technique is the use of retinaculum grafts. A systematic review of the biomechanical and histological properties of the bone–retinaculum–bone (BRB) graft and the clinical results of its use in SL ligament reconstruction was performed. Materials and Methods After abstract screening of 353 articles, a total of eight studies (five laboratory and three clinical) were included. Results Five cadaveric studies showed a lower load to failure and lower stiffness of the BRB compared with the scapholunate interosseous ligament. In patients with dynamic SL instability, treatment with BRB graft resulted in pain relief and an improvement in grip strength but with a reduced range of motion. Radiologically, no SL widening was found 18 months after surgery but with a slight increase after 12 years. The three clinical studies in this review have a level of evidence of 4. There were no studies on graft incorporation and remodeling. Conclusion There is insufficient clinical, histological, and biomechanical data available on the use of BRB grafts for SL ligament reconstruction.

An anatomical feasibility study using the first metatarsal head as a vascularized bone graft for proximal pole of scaphoid reconstruction.

A cadaveric study showed that vascularized transfer of the articular surface of the ipsilateral first metatarsal head with the lateral collateral ligament could be suitable for reconstruction of the proximal pole of scaphoid and scapholunate ligament. Further study of the technique is recommended.

Wrist &amp; Hand

The June 2024 Wrist &amp; Hand Roundup360 looks at: One-year outcomes of the anatomical front and back reconstruction for scapholunate dissociation; Limited intercarpal fusion versus proximal row carpectomy in the treatment of SLAC or SNAC wrist: results after 3.5 years; Prognostic factors for clinical outcomes after arthroscopic treatment of traumatic central tears of the triangular fibrocartilage complex; The rate of nonunion in the MRI-detected occult scaphoid fracture: a multicentre cohort study; Does correction of carpal malalignment influence the union rate of scaphoid nonunion surgery?; Provision of a home-based video-assisted therapy programme in thumb carpometacarpal arthroplasty; Is replantation associated with better hand function after traumatic hand amputation than after revision amputation?; Diagnostic performance of artificial intelligence for detection of scaphoid and distal radius fractures: a systematic review.

Open Surgical Excision of Dorsal Wrist Ganglia: Puncturing the Dome Reduces Surgery Time.

The following study is retrospective and compared the operative time and complications using two techniques of surgical resection of primary dorsal wrist ganglia in adults. Surgery was performed by the senior author (M.M.A.) through a transverse skin incision. The dome of the ganglion is dissected in both techniques. In the first technique (group A patients, n = 20 patients), dissection is continued to the base of the ganglion to reach the stalk near the scapho-lunate ligament. The stalk is transected and cauterized near the ligament. This surgical technique has been practiced by the senior author for 25 years. Over the last 5 years, the author has modified the technique (group B patients, n = 20 patients) by puncturing the dome of the ganglion following dome dissection. About two-thirds of the content of the ganglion is removed, and a mosquito is then used to close the puncture site. Dissection of the base of the ganglion to the stalk becomes easier and quicker, and the stalk is transected and cauterized near the scapho-lunate ligament. There was one recurrence in each group. Other complications were not seen in either group. The mean operative time (SD) was 30.75 (SD = 2.98) minutes for group A; and 20.75 (SD = 2.25) minutes for group B. An independent-samples t test was used to compare the operative time of both groups, which showed the difference was statistically significant (P < 0.001). Our study showed that intentionally puncturing the dome of the ganglion makes the dissection of the base quicker, without increasing the risk of complications.

Surgical repair of posttraumatic injuries of the scapholunate ligament: A literature study.

Scapholunate interosseous ligament rupture can cause wrist issues like pain, strength loss, and cartilage degeneration. While various surgical treatments exist, it's unclear which method is optimal. This study aims to determine the superior treatment approach for scapholunate dissociation. In Pubmed, Embase, Scopus and Web of Science was searched for articles reporting results of surgical repair of scapholunate dissociation. Additional inclusion criteria were English- and Dutch-language articles published between January 2000 and December 2022 with at least 8 patients and at least 1 year of follow-up. Seventeen articles were included, 9 covered tenodesis repair, 2 focused on capsulodesis, 3 on direct scapholunate ligament repair using bone anchors, and 3 on a combination of tenodesis and capsulodesis. No difference could be found between the types of surgical techniques in wrist mobility and grip strength. The Disability of Arm, Shoulder, and Hand score, Visual Analogue Scale for pain and Mayo wrist scores showed no clinically relevant difference. With all methods, normal radiological values were obtained after surgery. The mean scapholunate angle was less than 60° and the scapholunate gap less than 3 mm. However, at longer follow-up an increase in this angle and gap was seen again. This review did not allow to conclude that one technique was better than another to treat scapholunate dissociation because of poor quality of the included studies. Pre- and postoperative values were not always reported, there were insufficient comparative studies, and randomized prospective studies were missing.