Dorsal Intercarpal Ligament Capsulodesis for Chronic Scapholunate Instability
Nicolas Dreant, PH
Pole Urgence Main Nice, Nice, France
The treatment of chronic scapholunate instability is challenging and varying therapeutic options have been described. The aim of this study was to examine the results of dorsal intercarpal ligament capsulodesis for cases of chronic scapholunate dissociation before arthritis.
MATERIAL AND METHODS:
A retrospective analysis was conducted that examined dorsal intercarpal ligament capsulodesis procedures performed by the same operator for isolated chronic scapholunate instability between january of 2007 and december of 2015. The minimum follow-up period was 2 years. The wrist pain was present for greater than 3 months. 138 procedures were performed during that period using the Mayo technique : a dorsal capsulodesis with the proximal part of the dorsal intercarpal ligament remained attached to the scaphoid and inserted in the lunate with a bone anchor. 6 were excluded because of reoperation and 12 were lost of follow-up. Of the 120 examined patients 47 (40%) had predynamic, 48 (40%) had dynamic and 24 (20%) had static scapholunate instability. The time from injury to surgery averaged 18 months. The follow-up period averaged 54 months (range, 24-127). Results were reviewed clinically and radiologically. All the patients were assessed by the Mayo Wrist score (MWS), the Patient-Rated Wrist Evaluation (PRWE) and the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire.
Mean final range of motion was: flexion 48¡ (68% of contralateral side), extension 74¡ (90%), radial deviation 19¡ (82%), and ulnar deviation 32¡ (80%). Mean final grip strength was 40?kg (90%). Mean pain score improved from 6 to 2.5. Mean final MWS was 70, mean final PRWE was 18 and mean final QuickDASH score was 26. Radiological results (preoperative/final follow-up) were: scapholunate space at rest 4.5/2?mm; scapholunate space on stress views 4.2/3 mm ; scapholunate angle 69/57¡; radiolunate angle 39/32¡. 10 patients developed arthritic changes (SLAC I and II) and 6 of these had a reoperation. There was a statistical difference concerning the radiological results between the dynamic and predynamic groups and the static group. No other statistical difference was observed between these three groups.
We recommend the dorsal capsulodesis with the Mayo technique for treatment of chronic non-arthritic dynamic and predynamic scapholunate instability. For static scapholunate dissociation this technique doesÕnt provide maintenance of carpal alignment, and the wrists operated tend to evolve towards scapholunate advanced collapse despite good clinical results with a midterm follow-up.
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