J Korean Soc Surg Hand.  2016 Jun;21(2):55-62. 10.12790/jkssh.2016.21.2.55.

Analysis of the Postoperative Outcomes of the Chronic Scapholunate Ligament Instability Managed by Various Surgical Techniques

• Ahn KB
• Rhyou IH
• Kim KC
• Kim HJ
• Lee JH
• Moon SC

• KMID: 2328387
• DOI: http://doi.org/10.12790/jkssh.2016.21.2.55

Abstract

PURPOSE
To investigate mid-term clinical outcomes of various methods of scapholunate reconstruction for chronic scapholunate instability.
METHODS
We retrospectively reviewed 11 patients diagnosed as chronic scapholunate instability, from 2005 to 2013 and followed up for more than one year after surgery. 7 patients were treated with Garcia technique of triple ligament reconstruction, 2, bone-ligamemt-bone repair, and 2, dorsal capsulodesis. Mean age was 42 years (range, 23-61 years). The right side was involved in 6 patients, and the left in 5. The follow-up period averaged 42 months (range, 13-125 months). The postoperative functional outcomes were assessed with Modified Mayo wrist score (MMWS), disability of the arm, shoulder and hand (DASH) score and range of motion. The postoperative radiologic results were analyzed with the change of scapholunate angle and distance.
RESULTS
The mean MMWS score improved from 65 preoperatively to 77 postoperatively (p=0.072). The mean DASH score improved from 29.4 (range, 18.3-43.3) preoperatively to 12.7 (range, 0-38.3) postoperatively (p=0.003). The dorsiflexion increased from 67° to 78°, the volar flexion decreased from 51° to 45°, the supination increased from 69° to 88°, and the pronation increased from 62° to 66°. The SL angle changed from 55° preoperatively to 51° postoperatively, the mean SL distance changed from 3.4 mm preoperatively to 1.7 mm postoperatively.
CONCLUSION
The chronic scapholunate instability is amenable to various techniques and postoperative functional outcomes improved satisfactory.

Keyword

Chronic scapholunate instability; Ligament reconstruction

MeSH Terms

Arm
Follow-Up Studies
Hand
Humans
Ligaments*
Pronation
Range of Motion, Articular
Retrospective Studies
Shoulder
Supination
Wrist

Figure

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  Fig. 1. (A) Preoperative radiograph shows an anteroposterior view. (B-E) Photographs showing the operative procedure of scapholunate ligament reconstruction using half-strip of flexor carpi radialis tendon. (F, G) Radiographs taken at 12 months after operation.

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  Fig. 2. (A) Preoperative radiographs show normal. (B) Arthroscopic finding through midcarpal joint showing a step-off of scapholunate joint. (C, D) Photographs showing the operative procedure of bone-ligament-bone technique. (E) Radiographs taken at 36 months after operation.

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