Current Techniques in Scapholunate Ligament Reconstruction

doi:10.1016/j.ocl.2019.09.002

Orthopedic Clinics of North America

Volume 51, Issue 1, January 2020, Pages 77-86

https://doi.org/10.1016/j.ocl.2019.09.002 Get rights and content

Section snippets

Key points

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Perioperative counseling is paramount in patients with scapholunate ligament injury without evidence of arthrosis.
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Surgeons should approach patients with a treatment algorithm regarding ability to repair and or reconstruct the scapholunate ligament depending on reducibility of the deformity and absence of degenerative arthritis.
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Many repair and reconstructive techniques exist for scapholunate ligament reconstruction with no single, clear advantageous technique.
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Salvage operations exist when repair

Anatomy and biomechanics

The SL ligament is a C-shaped ligament that is composed of 3 main segments: a dorsal, proximal, and palmar segment.² The dorsal region of the ligament is the thickest component and is composed of transversely oriented collagen fibers that contribute most of the ligament’s tensile strength.²^,³ This dorsal segment primarily controls flexion and extension and contributes up to 300 N of tensile strength to the ligament complex.⁴ In contrast, the proximal portion of the ligament is composed

Classification

Garcia-Elias and colleagues⁹ proposed 5 important prognostic factors to consider when evaluating SL ligament injuries:

1.
Is the dorsal SL ligament intact?
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If the dorsal SL ligament is disrupted, can it be repaired with good healing potential?
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Is the scaphoid aligned normally with an radioscaphoid angle of 45° or less, indicating a normal STT capsule and ligaments?
4.
Is the carpal malalignment easily reducible?
5.
Is the cartilage at both radiocarpal and midcarpal joints normal?

They proposed that, by

Acute Injury with Repairable Ligament

These injuries are usually represented as occurring within 2 to 3 weeks of the inciting traumatic event. If surgery is attempted during this time interval, direct repair of the ligament is usually possible.¹⁰ The SL ligament almost invariably avulses off the scaphoid and repair techniques focus on using suture anchors with attached sutures to reattach the avulsed ligament. This direct repair is often augmented with a variety of other techniques. A popular treatment method has been to combine

Summary

Complete SL disruptions can lead to SLAC wrist deformity with associated loss of motion, loss of grip strength, and disability. Early recognition and treatment is ideal. If unrecognized or if patients present late with a chronic injury, various reconstruction options have been described with variable success. Additional prospective randomized control trials are needed comparing these various techniques with longer follow-up intervals to assess the durability of these procedures.