Long-Term Surgical Outcomes of Dorsal Capsulodesis and Three-Ligament Tenodesis in Midcarpal Instability: A Mean Follow-Up of 8 Years.

Abstract

Purpose: The long-term effectiveness of surgical stabilization for midcarpal instability (MCI), or carpal instability nondissociative, is often debated due to concerns about the potential weakening of the reinforced ligaments or joint capsule over time. Ligament reconstruction techniques like three-ligament tenodesis (3LT) may offer more durable stabilization than the more common dorsal capsulodesis, given the intraosseous nature of stabilization. However, comparative long-term studies are lacking. This study aimed to evaluate the durability of surgical stabilization for nontraumatic MCI and compare the long-term outcomes of 3LT with dorsal capsulodesis.

Methods: We included patients who underwent surgical stabilization for nontraumatic MCI with either dorsal capsulodesis or 3LT. Patient-reported pain and function were assessed using the patient-rated wrist evaluation (PRWE). Secondary outcomes included patient satisfaction and subsequent treatments. A linear mixed model was used to analyze PRWE scores across different time points during long-term follow-up and compare the outcomes between the two techniques.

Results: We contacted 179 patients for long-term follow-up, including 143 patients treated with dorsal capsulodesis and 36 with 3LT, at a mean follow-up duration of 8 years (range: 2.7-12.4 years). Both techniques showed significantly improved PRWE function, pain, and total scores from intake to 12 months after surgery, with sustained results over long-term follow-up. At 3 months after surgery, dorsal capsulodesis demonstrated significantly better PRWE total and pain scores compared with 3LT. However, this difference was not observed at 12 months or during the long-term follow-up. There was no difference in patient satisfaction or subsequent treatment rates between both the treatment groups.

Conclusions: Surgical stabilization provides durable, favorable outcomes for nontraumatic MCI, making it a reliable treatment option for patients who do not achieve sufficient relief from nonsurgical treatment. We prefer dorsal capsulodesis over the more invasive 3LT due to its quicker recovery and comparable, favorable long-term outcomes regarding pain, function, satisfaction, and subsequent treatment.

Type of study/level of evidence: Therapeutic II.