Mid-term Outcome of the All-Dorsal Augmented Scapholunate Ligament Reconstruction for Chronic Scapholunate Instability.

Abstract

Background: Chronic scapholunate instability can be treated with the all-dorsal scapholunate augmented reconstruction This study examined the mid-term outcome of a multicentre series of this technique.

Methods: Patients with chronic symptomatic scapholunate instability that underwent surgical treatment were included. Patients with wrist arthritis were excluded. Assessment consisted of clinical (range of motion, grip strength, pain), functional (Disabilities of the Arm, Shoulder and Hand [DASH] score; Patient-Related Wrist Evaluation [PRWE] score and patient satisfaction), and radiographic measurements (scapholunate distance, scapholunate angle, radiolunate angle, capitolunate angle, dorsal scaphoid translation, and drill hole diameter).

Results: Eighteen consecutive patients were included. The mean age was 44.4 years, and the mean follow-up was 4.2 years, with a minimum of 2 years. Five patients (27.8%) were unavailable for final follow-up due to revision surgery caused by recurrent symptomatic instability. Compared to the contralateral side, the mean postoperative flexion was 60.6%, extension 66.5%, and grip strength 62.0%. Postoperatively, the mean visual analogue scale pain score was 2.5, mean DASH score 17.9, and mean PRWE score 26.0. Postoperative radiographic parameters did not differ significantly from preoperative values. However, an increased dorsal scaphoid translation and scapholunate and capitolunate angle were observed in the cohort requiring revision. Postoperatively, 59% of drill holes significantly increased in size during follow-up. Radiographic bone collapse of the scaphoid or lunate was observed in 3 patients (16.8%).

Conclusions: Our mid-term study showed a high overall failure rate of 44.4% for the all-dorsal scapholunate augmented reconstruction. Failure occurred more in patients with higher degrees of scapholunate instability. The remaining patients had good clinical and functional outcomes.