Reduction and Association of the Scaphoid and Lunate Versus Internal Brace for Scapholunate Ligament Reconstruction

Abstract

Background:

The purpose of this study is to compare outcomes in patients with isolated unrepairable scapholunate (SL) injuries treated with the reduction and association of the scaphoid and lunate (RASL) screw technique versus suture anchors with an internal brace (IB).

Methods:

Patients treated with either the RASL screw or IB technique for a complete, nonrepairable SL injury were identified. Radiographic and clinical data were recorded preoperatively, immediate postoperatively, and at final follow-up. Patients were then contacted via telephone survey, and Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) questionnaire was administered. Patients with less than 6 months of follow-up were excluded.

Results:

Twenty-five patients (19 men, 6 women) with an average age of 43 (range = 23-66) years were identified (RASL = 14 and IB = 11). There were no differences between groups in radiographic parameters or range of motion at final follow-up, except for a smaller SL gap at final follow-up in RASL patients (1.5 vs 2.4 mm, P = .03). Four patients in the RASL (29%) group required additional procedures for screw removal secondary to screw breakage (n = 1) or screw migration/loosening (n = 3). One patient in the IB group had complete failure/diastasis postoperatively, and 36% (4/11) of patients had osteolysis at final follow-up. At final follow-up, qDASH was 26 versus 31 in the IB versus RASL groups (P = .79).

Conclusions:

Both RASL and IB have similar postoperative outcomes when treating SL injuries. It is important to note complications of screw breakage/loosening associated with RASL and recurrent diastasis/gapping and high rate of osteolysis with IB, although this has an unknown clinical significance.