Scapholunate Dissociation
Conditions
Keywords
scapholunate instability, reconstruction
Brief summary
Arthroscopical reconstruction of the volar and dorsal part of the scapholunate ligament as treatment for complete scapholunate ligament injury, but reducible carpal malalignment. This prospective study aims to evaluate the clinical and functional outcome of this technique on the short and middle term
Detailed description
Classical arthroscopic techniques for scapholunate instability consist of debridement, thermal shrinkage, and percutaneous pinning. Good results are obtained in acute lesions or in chronic partial tears, but they are less predictable when the lesion is complete, because of the poor healing capacity of the scapholunate ligament and because it is not possible to perform an anatomic ligamentous reconstruction with these techniques. Open techniques are thus required for reconstruction, but they damage the soft tissues. Corella et al. published a description and cadaver study of an arthroscopic ligamentoplasty, trying to combine the advantages of arthroscopic techniques (minimally invasive surgery) and open techniques (reconstruction of the ligament). With this approach, it is possible to reconstruct the dorsal scapholunate ligament and the secondary stabilizers while causing minimal damage to the soft tissues and avoiding injury to the posterior interosseous nerve and detachment of the dorsal intercarpal ligament. Arthroscopic scapholunate volar and dorsal ligament reconstruction achieves an anatomic reconstruction to provide a strong construct for early mobilization.
Interventions
PROCEDUREArthroscopic Scapholunate Ligament Reconstruction
reconstruction of the SL ligament with palmaris tendon graft tunneled through the scaphoid and lunate as described by Corella et al.
Sponsors
Regionaal Ziekenhuis Heilig Hart Tienen
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
prospective single center - single surgeon
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
Yes
Inclusion criteria
* Scapholunate dysfunction, complete irrepairable lesion of the SL ligament and the secondary stabilizers (RSC-LRL-SRL) EWAS stage 4-5, no arthritis, with reducible malalignment * 18 - 65 years
Exclusion criteria
* \- associated lesions, fractures * neurological disorder affecting the upper limb, history of wrist lesion involving the same wrist, dementia, substance abuse, severe psychiatric disorder and previous injured contralateral wrist
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Disabilities of the Arm, Shoulder and Hand score | preop | function score (0 is best -100 is worst) |
| passive and active range of motion (degrees) operated and contralateral side | preop | flexion, extension, ulnar and radial deviation |
| grip strength (kg) operated and contralateral side | preop | dynamometer (kg) |
| pain (visual analogue scale) | preop | Visual analogue Scale (0 no pain -10 cm worst pain) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| patient satisfaction after treatment | postoperative 12 months | visual analogue scale (0 is worst -10 cm is best) |
| complications | postoperative 12 months | descriptive |
| arthroscopical assessment of the scapholunate stability | intraoperative | according to European Wrist Arthroscopy Society classification (EWAS1 best -5 worst) |
| scapholunate distance, carpal angles | preop | radiological follow-up (distance in mm or angles in degrees) |
Countries
Belgium
Contacts
Primary Contactchul ki goorens, MD
Outcome results
None listed