Fig 4 - available via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International
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The extensor carpi radialis longus (ECRL) slips delivered volarly on opposite sides of the flexor carpi radialis (FCR) tendon.
Source publication
Background Even though the scapholunate interosseous ligament is the most common wrist ligament injury, its treatment remains a challenge for hand surgeons. We report on a surgical treatment (Dynadesis) for dynamic scaphoid instability (DSI) with a 20-year follow-up period.
Description of Technique Dynadesis utilizes antagonist forearm muscles in o...
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Citations
... This did not take into account the number of patients per study as individual results per patient were rarely reported. These tests could the function of the SL ligament 6,[9][10][11][12][13][14][15][16][17][18] . Variations exist based on the tendon used and the methods employed: modified Brunelli 11,14-16 , 3-ligament tenodesis 9 , scapholunotriquetral (SLT)-tenodesis 17 , and 4-boneligament reconstructions 18 19 . ...
... It's also uncertain if the difference between 50° and 65° is clinically significant. Some studies showed improved wrist mobility after tenodesis 10,13 , while others reported a decrease postoperatively 15,17 . Most studies lacked preoperative values, hindering determination of the ...
Background and research aims: Scapholunate interosseous ligament rupture can cause wrist issues like pain, strength loss, and cartilage degeneration. While various surgical treatments exist, it’s unclear which method is optimal. This study aims to determine the superior treatment approach for scapholunate dissociation. Methods: In Pubmed, Embase, Scopus and Web of Science was searched for articles reporting results of surgical repair of scapholunate dissociation. Additional inclusion criteria were English- and Dutch-language articles published between January 2000 and December 2022 with at least 8 patients and at least 1 year of follow-up. Results: Seventeen articles were included, 9 covered tenodesis repair, 2 focused on capsulodesis, 3 on direct scapholunate ligament repair using bone anchors, and 3 on a combination of tenodesis and capsulodesis. No difference could be found between the types of surgical techniques in wrist mobility and grip strength. The Disability of Arm, Shoulder, and Hand score, Visual Analogue Scale for pain and Mayo wrist scores showed no clinically relevant difference. With all methods, normal radiological values were obtained after surgery. The mean scapholunate angle was less than 60° and the scapholunate gap less than 3 mm. However, at longer follow-up an increase in this angle and gap was seen again. Discussion: This review did not allow to conclude that one technique was better than another to treat scapholunate dissociation because of poor quality of the included studies. Pre- and postoperative values were not always reported, there were insufficient comparative studies, and randomized prospective studies were missing.
Background
Kienbock’s disorder is a degenerative wrist disease that is largely defined by idiopathic lunate bone avascular necrosis. This research objective was to assess the Scaphocapitate arthrodesis (SCA) efficacy in terms of wrist motion improvement, pain relief, and radiographic alterations in comparison to SCA without lunate excision.
Methods
This observational prospective study was conducted on 20 patients with Kienbock’s disease (stage ІІІB), who attended Benha University Hospital Orthopedics Clinic or Shebin Teaching Hospital. All patients were allocated into two groups; group 1 ( n =10) involved patients with lunate excision and group 2 ( n =10) involved patients without lunate excision. All participants were assessed through clinical examination full history taking, and radiological assessment by plain radiography and confirmed by computed tomography to assess if there is arthritic changes or not and MRI.
Results
Regarding the functional outcome, the postoperative grip strength and modified mayo wrist score increased significantly in group 1 as regard to group 2 ( P =0.001, 0.033). The pain outcome differed significantly among both groups ( P =0.019), being better in group 1 compared with group 2. The satisfactory outcome significantly differed between both groups ( P =0.001), group 1 showed superior satisfaction compared with group 2.
Conclusion
SCA with lunate excision showed superior radiological and functional outcomes, better pain relief, and a higher satisfaction rate in Kienbock’s disease management.
Background There is a paucity of information on minimal surgical intervention for the treatment of chronic dynamic scaphoid instability (CDSI) that will achieve an acceptable mid-term result.
Purpose We hypothesize that by following a debride-first-then-wait protocol, some patients with CDSI can be treated with arthroscopic debridement alone and avoid a reconstructive procedure.
Patients and Methods We performed a retrospective, longitudinal study from January 2008 to December 2018 of all patients diagnosed with CDSI and treated with arthroscopic debridement of the scapholunate interosseous ligament. In all cases, a debride-first-then-wait protocol was followed that included a predetermined wait period after arthroscopic debridement, giving the patient a chance to experience possible symptom improvement. This approach integrated the patient's perceived wellness into the decision-making process. All wrists that remained symptomatic or experienced recurrence of symptoms were treated with a reconstructive procedure. The wrists were divided into two groups: arthroscopic debridement only (ADO) and reconstructive procedure (RP).
Results Seventy-nine wrists (72 patients) of 191 consecutive wrist arthroscopies met the inclusion criteria. The ADO group consisted of 43 wrists (54%). An average of 6.3 years later (range: 2–11 years), these patients remained satisfied with the results of the arthroscopic debridement and did not want further treatment. The RP group included 36 wrists (46%) with 91.7% of reconstructive surgeries occurring within 6 months of the arthroscopy. With a mid-term follow-up, 75% of Geissler grade II ligament tears, 48% of grade III tears, and 39% of grade IV tears were successfully treated with arthroscopic debridement alone and avoided a reconstructive surgery.
Conclusion By adopting a debride-first-then-wait protocol, some patients with CDSI can be treated with a more limited intervention, arthroscopic debridement. In this series, 54% of wrists with CDSI avoided a reconstructive surgery for an average of 6.3 years.
Type of Study / Level of Evidence Case Series, Level IV.
Unlabelled:
Scapholunate dissociation is the most common form of carpal instability. This retrospective case series aimed to assess long-term results obtained by treating scapholunate instability with dynamic tenodesis using the entire extensor carpi radialis brevis tendon, which is detached from the base of the third metacarpal, rerouted in the third extensor compartment, and fixed at the distal portion of the scaphoid to maintain reduced rotatory subluxation.
Methods:
Nine patients with scapholunate instability were treated. We reviewed eight patients with a mean follow-up of 12 years. One subgroup of four patients was affected by static scapholunate instability, and the other by dynamic scapholunate instability. Disability of the Arm, Shoulder, and Hand score, Patient Rated Wrist Evaluation score, modified Mayo score, and radiographs were used to determine functional and anatomical outcomes.
Results:
Excellent functional results did not correlate with radiological outcome in patients with static scapholunate instability. In this subgroup, scapholunate angle and gap and radiolunate angle improved in average but remained in the pathologic range. In only one of these patients, osteoarthritis was observed. In the subgroup of patients affected by dynamic instability, very good functional outcomes correlate with radiological results, except in one patient who developed arthritic changes.
Conclusions:
Dynamic tethering of the scaphoid with the extensor carpi radialis brevis tendon might be indicated in the treatment not only in patients affected by dynamic scapholunate instability but also in patients with static instability. Prospective studies with a larger number of patients are required to evaluate this method.
