Comparing outcomes of dorsal capsulodesis techniques for chronic (pre-)dynamic scapholunate interosseus ligament tear repair: A systematic review.

Background and study aim: Scapholunate interosseous ligament (SLIL) injuries, crucial for wrist stability, can cause significant dysfunction and lead to scapholunate advanced collapse (SLAC) wrist. This review compares open and arthroscopic dorsal capsulodesis techniques for chronic (pre-)dynamic SLIL tears, aiming to identify the most effective method for optimizing outcomes and preventing SLAC wrist progression.

Methods: A systematic search of PubMed, Embase, Web of Science, and Cochrane Library was performed. Fourteen studies met inclusion criteria. Included studies assessed long-term clinical, patient reported and radiographic outcomes (≥6 weeks post-injury). Studies combining dorsal capsulodesis with other techniques (except primary ligament repair) were excluded. Heterogeneous outcome measures precluded statistical comparison.

Results: While older techniques (Lavernia, Blatt) resulted in significant ROM loss and failed to prevent SLAC wrist, newer open procedures (Berger, Modified Viegas) showed improved results, with the Modified Viegas technique demonstrating less ROM decrease. The all-arthroscopic Mathoulin procedure showed the most promising results regarding clinical, patient-reported outcomes, and SLAC wrist prevention. Thermal shrinkage/abrasion showed the worst outcomes.

Conclusion: Since open procedures also require arthroscopy, all-arthroscopic techniques may be more cost efficient. The Mathoulin procedure appears the most effective even in severe tears and less favorable cases, although this review suggests some open procedures may not necessarily lead to greater ROM loss than arthroscopic ones. The Mathoulin procedure shows promise for chronic SLIL tears without arthritis and may fit into current treatment algorithms. However, larger trials with longer follow-up are needed.