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Left untreated, scapholunate (SL) ligament tears can result in a predictable pattern of radiocarpal arthritis, termed SL advanced collapse (SLAC).
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SL reconstruction is indicated in symptomatic patients without evidence of radiocarpal arthritis. Patients with established radiocarpal arthritis may be better served with a salvage procedure.
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Most current treatments have not been shown to reliably maintain reduction of the SL interval and SL angle at long-term follow-up.
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Currently there is no consensus
Scapholunate Ligament Tears: Acute Reconstructive Options
Section snippets
Key points
Capsulodesis
Acute surgical intervention is believed to improve outcomes with the goal of intervening before arthritic changes have set in. Capsulodesis is designed is to reinforce the extrinsic ligaments. Unfortunately, the procedure often sacrifices postoperative flexion. It is indicated in both chronic and subacute settings. It was classically described without SL ligament repair; however, when possible, a ligamentous repair should be done. Since the original description by Blatt in 1987,20 multiple
Summary
SL reconstruction is indicated in patients with symptomatic SL instability and absences of radiographic degenerative changes in the radiocarpal joint. Most current treatments fail to reliably maintain reduction of the SL interval and SL angle at long-term follow-up and result in decreased wrist range of motion and possibly pain. Further research is needed to determine the optimal treatment of this condition.
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Cited by (8)
Motion and Strength Analysis of 2-Tine Staple and K-Wire Fixation in Scapholunate Ligament Stabilization in a Cadaver Model
2021, Journal of Hand Surgery Global OnlineCitation Excerpt :Fixation of the SL interval with K-wires significantly decreased the range of motion of the scaphoid and lunate compared with normal wrists during a dart-throw motion. K-wire fixation and other popular methods of SLIL repair require long periods of immobilization postoperatively to allow the healing of the repair and because scaphoid and lunate kinematics are disrupted while the K-wires are in place.4,7,10 Additionally, K-wire fixation has a risk of pin site infection or migration that may lead to articular cartilage damage.6
Dorsal Scaphoid Subluxation on Sagittal Magnetic Resonance Imaging as a Marker for Scapholunate Ligament Tear
2017, Journal of Hand SurgeryDart-throwing motion with a twist orthoses: Design, fabrication, and clinical tips
2016, Journal of Hand TherapyEarly controlled mobilization using dart-throwing motion with a twist for the conservative management of an intra-articular distal radius fracture and scapholunate ligament injury: A case report
2016, Journal of Hand TherapyCitation Excerpt :However, Garcia-Elias et al21,30 recommended caution in cases involving complete S-L ligament injury as DTM may not provide adequate protection without additional stabilization or fixation between the scaphoid and lunate bones. Moreover, if the S-L ligament repair involves fixation that crosses the midcarpal joint, then DTM would not be possible while such fixation is in place.11-15 This case report describes an early controlled DTM approach as an alternative to immobilization for the conservative management of a stable minimally displaced, intra-articular, and distal radius (radial styloid) fracture with an associated S-L ligament injury.4,5
Additive Manufacturing: The Next Generation of Scapholunate Ligament Reconstruction
2021, Journal of Wrist Surgery