Cartilage damage in patients with scapholunate lesions: arthroscopic prevalence, location and associated clinical factors.

Abstract

Introduction: Scapholunate ligament (SLL) injuries can lead to instability and osteoarthritis through stages of scapholunate dissociation and scapholunate advanced collapse. Although cartilage damage is traditionally seen as a late finding, recent evidence suggests that it may occur earlier. This study aimed to assess the prevalence and distribution of cartilage damage in patients with isolated SLL lesions confirmed by arthroscopy and to explore associated sociodemographic and clinical factors.

Methods: A retrospective cohort study was conducted in patients with arthroscopically confirmed SLL lesions. Baseline demographics, injury duration, and Patient Rated Wrist Hand Evaluation (PRWHE) scores were routinely collected prior to arthroscopy. Arthroscopic findings documented cartilage damage at the scaphoid (fossa), capitate, lunate (fossa), hamate and triquetrum. Prevalence was analysed descriptively, and associations were tested using univariate logistic regression.

Results: Of 226 included patients, 33.2% showed cartilage damage, most commonly affecting the scaphoid and scaphoid fossa. Damage was present across all Geissler grades, including patients without prior fractures. It was more frequent in older males, those with Geissler IV lesions, prior wrist fractures and those less likely to report a clear traumatic event. No association was found with symptom duration, dominant hand, occupation or PRWHE scores.

Conclusion: The presence of cartilage damage across all Geissler grades challenges the idea that it is a late-stage finding. These results support the need for a revised classification system that integrates both ligament and cartilage pathology to enable more tailored treatment strategies for scapholunate ligament injuries.

Level of evidence: Level III (Cohort study).