Functional and radiological outcomes of the all-dorsal technique for scapholunate ligament reconstruction

Abstract

Introduction:

Scapholunate instability is a common and challenging wrist pathology with no universally accepted surgical solution. The all-dorsal scapholunate reconstruction technique restores the dorsal ligament with an extensor carpi radialis brevis tendon autograft. The aim of this study was to assess outcomes in patients with a chronic scapholunate ligament rupture.

Methods:

We retrospectively analysed 31 patients. Outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score and a visual analogue scale score for pain. Clinical examination included wrist range of motion and grip strength. The radiological parameters measured were scapholunate (SL) angle and gap. Follow-up averaged 39 months (range 12–84) for all outcomes.

Results:

Postoperatively median pain scores improved from 5 to 2 and disability scores from 58 to 48, although changes were not statistically significant. Median wrist extension at final follow-up measured 50° (IQR 42.5 to 70) and flexion 45° (IQR 39 to 60). Radiographically, there was persistent carpal malalignment with a median SL angle of 66° (IQR 58 to 73), a static SL gap of 3 mm (IQR 2.2 to 4) and a dynamic SL gap of 4.8 mm (IQR 3.3 to 5.4). Median grip strength improved from 28 kg (IQR 20 to 40) preoperatively to 29 kg (20–37) postoperatively. Five patients required salvage procedures owing to progressive symptomatic osteoarthritis. Complications included complex regional pain syndrome (n = 3), transient nerve symptoms (n = 2), anchor-site osteolysis (n = 13) and isolated scaphocapitate joint osteoarthritis (n = 5).

Conclusion:

The relative simplicity and preservation of wrist function with the all-dorsal reconstruction technique justify its continued use, despite high complication and revision incidences.

Level of Evidence:

Level IV