Mid-term outcomes of scapholunate ligament reconstruction with internal brace augmentation

Abstract

Introduction:

Scapholunate ligament injury may cause carpal instability leading to pain, dysfunction and risk of scapholunate advanced collapse (SLAC) if untreated. Chronic dissociation is challenging to manage, with no clear reference standard reconstruction technique. This study aimed to evaluate the outcomes of scapholunate ligament reconstruction using an extensor carpi radialis brevis autograft and internal brace augmentation.

Methods:

We prospectively enrolled 12 patients with symptomatic chronic scapholunate (SL) dissociation treated between 2020 and 2024. Clinical outcomes included a visual analogue scale for pain, Mayo Wrist Score, QuickDASH, grip strength, range of motion and patient satisfaction. Radiographic outcomes included scapholunate gap, scapholunate angle and carpal height ratio. Patients were followed for a mean of 27.1 months.

Results:

The median pain visual analogue score improved from 7 preoperatively to 2 at final follow-up (p < 0.001). QuickDASH decreased from 43 to 6 (p < 0.001), and Mayo score improved from 37 to 75 (p < 0.001). Grip strength increased from 35 to 40.8 kg (p < 0.001), approaching values of the contralateral hand. Radiographs showed reduction of the SL gap and correction of SL angle to near-normal values, with no loss of carpal height. No patient showed progression of SLAC during the study period. All patients returned to pre-injury work or sport.

Conclusion:

Scapholunate reconstruction using extensor carpi radialis brevis autograft with internal brace augmentation provides reliable mid-term outcomes, restoring stability, function and strength. This technique proved effective even in patients with early degenerative changes, offering postoperative satisfaction and potentially delaying arthritis progression.

Level of Evidence:

IV