Reconstruction of an Early-Stage Scapholunate Advanced Collapse Wrist with the 3-Ligament Tenodesis Procedure: A Controversial Reappraisal.

Abstract

Background: The authors hypothesized that the 3-ligament tenodesis (3-LT) procedure is still sufficient-even in scapholunate advanced collapse (SLAC) cases-to reduce pain and improve wrist function. The authors compared patient-reported outcomes of scapholunate interosseus ligament (SLIL) injury patients with SLAC, to SLIL injury patients treated with 3-LT, and then to patients who underwent proximal row carpectomy (PRC), as a control group.

Methods: The authors included all patients with a traumatic SLIL injury and associated SLAC components treated with 3-LT and completed patient-rated wrist evaluation (PRWE) questionnaires preoperatively and at 12-month follow-up. First, the authors compared matched patients with SLIL injury and SLIL injury with SLAC, stage 1 to 3, who received 3-LT. Second, the authors compared patients who received 3-LT with patients who underwent PRC, while having SLAC stage 2 or 3.

Results: The authors compared 51 patients with SLAC to 95 patients with SLIL injury who had a 3-LT procedure, and 10 3-LT patients were compared with 18 patients undergoing PRC, given SLAC stage 2 or 3. In both analyses, the PRWE scores had significantly improved in all groups; however, no significant differences in PRWE were found between 3-LT in SLIL injury and SLIL injury with SLAC (6.9 points; 95% CI, -14.92 to 1.22; P = 0.096) and between 3-LT and PRC, given SLAC stage 2 or 3, 15.1 points (not enough power).

Conclusions: There is no difference in PRWE between matched SLIL injury patients with or without degenerative changes treated with a 3-LT. Therefore, the 3-LT procedure seems to be a viable treatment option for patients with early-stage SLAC wrist.

Clinical question/level of evidence: Therapeutic, III.