Modified Brunelli Reconstruction for Scapholunate Ligament Dissociation

Background: The present video article describes the steps, alternatives, and outcomes of the modified Brunelli reconstruction, also known as 3-ligament tenodesis, for the treatment of irreparable scapholunate dissociations. Description: The presently described technique is generally utilized in cases in which there is an irreparable disruption of the scapholunate ligament and widening of the scapholunate junction with no carpal arthritis. Alternatives: Other treatment options for irreparable scapholunate dissociation include various forms of capsulotenodesis, bone-ligament-bone reconstruction, tendon-based reconstructions, partial wrist arthrodesis, and proximal row carpectomy. Rationale: The modified Brunelli reconstruction is indicated for a nonrepairable complete scapholunate ligament injury with a reducible rotatory subluxation of the scaphoid, without cartilage degeneration. The dorsal scapholunate ligament is reconstructed and the distal palmar scaphoid rotation is corrected with use of a distally based flexor carpi radialis tendon. The reconstruction is achieved by placing the flexor carpi radialis tendon through a transosseous scaphoid tunnel and weaving the tendon through the dorsal ulnar capsule or radiotriquetral ligament. Expected Outcomes: The modified Brunelli technique has been shown to restore wrist motion to 70% to 80% of that of the contralateral wrist and grip strength to 65% to 75% of that of the contralateral wrist, as well as to provide good pain relief in approximately 70% to 80% of patients. Important Tips: With use of simple instrumentation, C-arm fluoroscopy, and proper surgical technique, this operative procedure is fairly reproducible. Acronyms and Abbreviations: FCR = flexor carpi radialis K-wire = Kirschner wire