Revista de la Asociación Argentina de Ortopedia y Traumatología
On-line version ISSN 1852-7434
CARLI, Pablo de et al. Scapholunate dissociation: reconstructive technique combining a new dorsal tenodesis and a ligament capsulodesis through a single approach. Preliminary results. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2012, vol.77, n.1, pp. 17-28. ISSN 1852-7434.
Background: The aim of this study is to describe a new reconstructive technique combining dorsal tenodesis and ligament capsulodesis for the treatment of chronic scapholunate dissociation (SLD). Methods: A retrospective evaluation was done of 8 patients (7 men) presenting chronic SLD with static carpal instability treated with a new reconstructive technique developed by the authors using a strip of the extensor carpi radialis longus and the dorsal intercarpal ligament. Average age: 39. Minimum follow-up: 1 year. The clinical evaluation included: comparative ranges of motion and grip strength, pain (VAS), and functional scores of DASH and Wrightington. Radiological evaluation: scapholunate space, radioscaphoid and scapholunate angles, and arthrosis. Mean follow-up: 23 months (12-58). Results: Final ranges of motion: flexion = 51° (60% that of the contralateral), extension = 70° (82%), ulnar deviation = 28° (74%), radial deviation = 20° (83%). Mean grip strength = 54lbs (74%). Mean pain (VAS): 3 (1-5).DASH and Wrightington scores: 13 (0.83-30) and 73 (65-90), respectively. Functional results were excellent in 2 cases and good in 6 cases. There was no recurrence of carpal collapse. One patient presented moderate midcarpal arthrosis. Conclusions: These preliminary results suggest that this new reconstructive technique represents a simple (only dorsal approach), safe (avoids perforation of the scaphoid with a risk of fracture or necrosis), and effective alternative to treat this difficult pathology.
Keywords : Scapholunate dissociation; Carpal instability; SLAC wrist; Capsulodesis; Tenodesis.