DORSAL INTERCARPAL LIGAMENT CAPSULODESIS FOR CHRONIC STATIC SCAPHOLUNATE DISSOCIATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 YANGYong ¹ , TsaiTsumin ² , CHENShanlin ¹ , LIZhongzhe ¹ , TIANGuanglei ¹

1. Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P. R. China;
2. Christine M. Kleinert Institute for Hand and Microsurgery, University of Louisville, USA;

Corresponding author：

YANGYong, Email: 0414yang@sina.com

Keywords：

Carpal instability; Chronic static scapholunate dissociation; Ligament reconstruction; Dorsal intercarpal ligament capsulodesis

DOI：

10.7507/1002-1892.20140258

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Objective To investigate the radiographic and clinical outcomes of dorsal intercarpal ligament capsulodesis (DILC) procedure for chronic static scapholunate dissociation. Methods Between January 2008 and January 2011, 12 patients with chronic static scapholunate dissociation were treated with DILC. Of 12 cases, 10 were male and 2 were female with an average age of 42 years (range, 20-66 years). All injuries were caused by falling. The interval from injury to surgery was 3-19 months (mean, 8 months). Physical examination at admission showed wrist tenderness and limited range of motion (ROM). Radiological examination showed that scapholunate gap was greater than 3 mm on posteroanterior view, and scapholunate angle more than 60° on the lateral view. Before operation, the grip strength was (25.4±8.2) kg; the wrist ROM was (56.7±11.5)° in flexion and (52.0±15.2)° in extension; visual analogue scale (VAS) score was 6.3±1.4; and disabilities of arm, shoulder & hand (DASH) score was 39.5±7.4. According to Garcia-Elias staging criteria, all cases were rated as stage 4, indicating that the scapholunate interosseous ligament was completely injured and reduction could easily be obtained. Eight patients had wrist instability. Results Primary healing of incision was achieved, no complication was found. All patients were followed up 13-34 months (mean, 15.9 months). During surgery, all deformities were corrected completely, but 7 patients (58%) recurred at 1 month after Kirschner wire removal. Compared with preoperative ones, the scapholunate gap, scapholunate angle, radiolunate angle, lunocapitate angle, and wrist height ratio at 1 month after Kirschner wire removal and last follow-up showed no significant difference (P > 0.05); the wrist flexion and extension ROM were significantly decreaed to (46.8±7.2)° and (42.0±9.0)° at last follow-up (P < 0.05); the grip strength was significantly increased to (32.7±9.6) kg at last follow-up (P < 0.05); VAS score and DASH score were improved to 1.7±1.0 and 8.1±8.7 (P < 0.05). Conclusion Carpal collapse will recur in short time after DILC. DILC is not the best way to treat chronic static scapholunate dissociation.

Citation： YANGYong, TsaiTsumin, CHENShanlin, LIZhongzhe, TIANGuanglei. DORSAL INTERCARPAL LIGAMENT CAPSULODESIS FOR CHRONIC STATIC SCAPHOLUNATE DISSOCIATION. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1189-1193. doi: 10.7507/1002-1892.20140258 Copy

1.	Manuel J, Moran SL.The diagnosis and treatment of scapholunate instability.Hand Clin, 2010, 26(1):129-144.
2.	Watson HK, Ballet FL.The SLAC wrist:scapholunate advanced collapse pattern of degenerative arthritis.J Hand Surg (Am), 1984, 9(3):358-365.
3.	Omori S, Moritomo H, Omokawa S, et al.In vivo 3-dimensional analysis of dorsal intercalated segment instability deformity secondary to scapholunate dissociation:a preliminary report.J Hand Surg (Am), 2013, 38(7):1346-1355.
4.	Walsh JJ, Berger RA, Cooney WP.Current status of scapholunate interosseous ligament injuries.J Am Acad Orthop Surg, 2002, 10(1):32-42.
5.	Hsu JW, Kollitz KM, Jegapragasan M, et al.Radiographic evaluation of the modified Brunelli technique versus a scapholunotriquetral transosseous tenodesis technique for scapholunate dissociation.J Hand Surg (Am), 2014, 39(6):1041-1049.
6.	6Finsen V, Borchgrevink GE.Poor results of radio-scaphoid capsulodesis for scapholunate dissociation.Hand Surg, 2013, 18(3):337-341.
7.	Pauchard N, Dederichs A, Segret J, et al.The role of three-ligament tenodesis in the treatment of chronic scapholunate instability.J Hand Surg (Eur Vol), 2013, 38(7):758-766.
8.	Garcia-Elias M, Lluch AL, Stanley JK.Three-ligament tenodesis for the treatment of scapholunate dissociation:indications and surgical technique.J Hand Surg (Am), 2006, 31(1):125-134.
9.	Peterson HA, Lipscomb PR.Intercarpal arthrodesis.Arch Surg, 1967, 95(1):127-134.
10.	Blatt G.Capsulodesis in reconstructive hand surgery.Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna.Hand Clin, 1987, 3(1):81-102.
11.	Brunelli GA, Brunelli GR.A new technique to correct carpal instability with scaphoid rotary subluxation:a preliminary report.J Hand Surg (Am), 1995, 20(3 Pt 2):S82-85.
12.	Cohen MS, Kozin SH.Degenerative arthritis of the wrist:proximal row carpectomy versus scaphoid excision and four-corner arthrodesis.J Hand Surg (Am), 2001, 26(1):94-104.
13.	1Harvey EJ, Hanel DP.Bone-ligament-bone reconstruction for scapholunate disruption.Tech Hand Up Extrem Surg, 2002, 6(1):2-5.
14.	Moran SL, Cooney WP, Berger RA, et al.Capsulodesis for the treatment of chronic scapholunate instability.J Hand Surg (Am), 2005, 30(1):16-23.
15.	Szabo RM, Slater RR Jr, Palumbo CF, et al.Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation:clinical results.J Hand Surg (Am), 2002, 27(6):978-984.
16.	Gajendran VK, Peterson B, Slater RR Jr, et al.Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation.J Hand Surg (Am), 2007, 32(9):1323-1333.
17.	Moran SL, Ford KS, Wulf CA, et al.Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability.J Hand Surg (Am), 2006, 31(9):1438-1446.
18.	Berger RA, Bishop AT, Bettinger PC.New dorsal capsulotomy for the surgical exposure of the wrist.Ann Plast Surg, 1995, 35(1):54-59.
19.	Wyrick JD, Youse BD, Kiefhaber TR.Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation.J Hand Surg (Br), 1998, 23(6):776-780.
20.	Kindynis P, Resnick D, Kang HS, et al.Demonstration of the scapholunate space with radiography.Radiology, 1990, 175(1):278-280.
21.	Larsen CF, Mathiesen FK, Lindequist S.Measurements of carpal bone angles on lateral wrist radiographs.J Hand Surg (Am), 1991, 16(5):888-893.
22.	Nattrass GR, King GJ, McMurtry RY, et al.An alternative method for determination of the carpal height ratio.J Bone Joint Surg (Am), 1994, 76(1):88-94.

1. Manuel J, Moran SL.The diagnosis and treatment of scapholunate instability.Hand Clin, 2010, 26(1):129-144.
2. Watson HK, Ballet FL.The SLAC wrist:scapholunate advanced collapse pattern of degenerative arthritis.J Hand Surg (Am), 1984, 9(3):358-365.
3. Omori S, Moritomo H, Omokawa S, et al.In vivo 3-dimensional analysis of dorsal intercalated segment instability deformity secondary to scapholunate dissociation:a preliminary report.J Hand Surg (Am), 2013, 38(7):1346-1355.
4. Walsh JJ, Berger RA, Cooney WP.Current status of scapholunate interosseous ligament injuries.J Am Acad Orthop Surg, 2002, 10(1):32-42.
5. Hsu JW, Kollitz KM, Jegapragasan M, et al.Radiographic evaluation of the modified Brunelli technique versus a scapholunotriquetral transosseous tenodesis technique for scapholunate dissociation.J Hand Surg (Am), 2014, 39(6):1041-1049.
6. 6Finsen V, Borchgrevink GE.Poor results of radio-scaphoid capsulodesis for scapholunate dissociation.Hand Surg, 2013, 18(3):337-341.
7. Pauchard N, Dederichs A, Segret J, et al.The role of three-ligament tenodesis in the treatment of chronic scapholunate instability.J Hand Surg (Eur Vol), 2013, 38(7):758-766.
8. Garcia-Elias M, Lluch AL, Stanley JK.Three-ligament tenodesis for the treatment of scapholunate dissociation:indications and surgical technique.J Hand Surg (Am), 2006, 31(1):125-134.
9. Peterson HA, Lipscomb PR.Intercarpal arthrodesis.Arch Surg, 1967, 95(1):127-134.
10. Blatt G.Capsulodesis in reconstructive hand surgery.Dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna.Hand Clin, 1987, 3(1):81-102.
11. Brunelli GA, Brunelli GR.A new technique to correct carpal instability with scaphoid rotary subluxation:a preliminary report.J Hand Surg (Am), 1995, 20(3 Pt 2):S82-85.
12. Cohen MS, Kozin SH.Degenerative arthritis of the wrist:proximal row carpectomy versus scaphoid excision and four-corner arthrodesis.J Hand Surg (Am), 2001, 26(1):94-104.
13. 1Harvey EJ, Hanel DP.Bone-ligament-bone reconstruction for scapholunate disruption.Tech Hand Up Extrem Surg, 2002, 6(1):2-5.
14. Moran SL, Cooney WP, Berger RA, et al.Capsulodesis for the treatment of chronic scapholunate instability.J Hand Surg (Am), 2005, 30(1):16-23.
15. Szabo RM, Slater RR Jr, Palumbo CF, et al.Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation:clinical results.J Hand Surg (Am), 2002, 27(6):978-984.
16. Gajendran VK, Peterson B, Slater RR Jr, et al.Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation.J Hand Surg (Am), 2007, 32(9):1323-1333.
17. Moran SL, Ford KS, Wulf CA, et al.Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability.J Hand Surg (Am), 2006, 31(9):1438-1446.
18. Berger RA, Bishop AT, Bettinger PC.New dorsal capsulotomy for the surgical exposure of the wrist.Ann Plast Surg, 1995, 35(1):54-59.
19. Wyrick JD, Youse BD, Kiefhaber TR.Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation.J Hand Surg (Br), 1998, 23(6):776-780.
20. Kindynis P, Resnick D, Kang HS, et al.Demonstration of the scapholunate space with radiography.Radiology, 1990, 175(1):278-280.
21. Larsen CF, Mathiesen FK, Lindequist S.Measurements of carpal bone angles on lateral wrist radiographs.J Hand Surg (Am), 1991, 16(5):888-893.
22. Nattrass GR, King GJ, McMurtry RY, et al.An alternative method for determination of the carpal height ratio.J Bone Joint Surg (Am), 1994, 76(1):88-94.

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