Scapholunate reconstruction by arthroscopy: An innovative approach in treating complex joint injuries

Abstract

Background

Scapholunate ligament injuries can lead to chronic wrist pain and instability if not properly addressed. Arthroscopic techniques have evolved to provide minimally invasive solutions, offering excellent visualization and preservation of surrounding tissues. The 360-degree arthroscopic reconstruction technique provides a comprehensive approach, avoiding the use of synthetic implants, which may reduce complications and improve outcomes.

Objective

To describe step by step a 360-degree arthroscopic technique for scapholunate ligament reconstruction and outline all the steps necessary to make this technique practical and easily applicable for hand surgeons worldwide, even without access to specialized materials.

Methods

This technique utilizes autologous (palmaris longus tendon) grafts to reconstruct the scapholunate ligament under arthroscopic guidance, enabling precise and comprehensive repair through a 2.4 mm arthroscope via mediocarpal portals and two mini-incisions—one volar and one ulnar. The procedure completely preserves the integrity of the wrist joint capsule, allowing for early range of motion with minimal restrictions, resulting in high patient satisfaction and minimal morbidity. No synthetic materials or anchors are employed. The technique ensures full circumferential reconstruction around the scapholunate joint, maintaining joint stability while promoting natural healing. Post-operatively, a structured hand rehabilitation protocol is initiated early to promote mobility and function, focusing on reducing stiffness while protecting the repair.

Results

From 2019 to 2024, 17 patients with chronic scapholunate ligament injuries, without radiocarpal or midcarpal arthritis, underwent this technique. There was an improvement in the DASH score in the pre- and postoperative comparison of these patients. The overall average range of motion was 78 degrees of flexion, 66 degrees of extension, 10 degrees of radial deviation, 32 degrees of ulnar deviation, 90 degrees of supination, and 80 degrees of pronation. Radiographic control at 3 months showed no widening of the scapholunate space, and the scapholunate angle was 38 degrees. All patients returned to sports and work without restrictions. The early hand rehabilitation protocol has demonstrated improved recovery times and range of motion when compared to traditional immobilization protocols.

Conclusion

Arthroscopic 360-degree reconstruction without synthetic materials offers a promising alternative for treating scapholunate ligament injuries. When combined with an early rehabilitation protocol, it enhances functional recovery while minimizing complications, making it a valuable technique in wrist surgery worldwide with low cost.