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Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options.

ABSTRACT: Purpose This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. Methods A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist guided the reporting and data abstraction. Descriptive statistics and forest plots are presented. Results A total of 14 studies with 342 patients were included for analysis. Treatments were categorized into four groups: electrothermal shrinkage (ES), arthroscopic capsuloplasty (AC), open capsulodesis (OC), and no treatment (NT). There were five studies in the ES group ( N = 69, mean age = 34.3 ± 3.3 years), three studies in the AC group ( N = 138, mean age = 32.2 ± 3.8 years), five studies in the OC group ( N = 123, mean age of 30.7 ± 7.8 years), and one study in the NT group ( N = 12, mean age = 43 years, range = 28-67 years). The average postintervention visual analog scale pain score for the ES group was 1.4 ± 0.5 (from 5.7 ± 1.8), for the AC group was 3.2 ± 1.3 (from 6.6 ± 0), for the OC group was 2.3 ± 2.1 (from 5.6 ± 1.6), and for the NT group was 3.2 (from 7.6). The wrist extension range of motion improved postoperatively for all intervention groups (ES = 66.3°-70.7°; AC = 67°-74.5°; and OC = 48.9°-63.5°), whereas it remained unchanged for the NT group (46°-45°). Grip strength also improved in all intervention groups (ES = 17.9-29.9 kg; AC = 24.0-32.2 kg; and OC = 15.8-26.6 kg), while the NT group remained unchanged (25-24 kg). The radiographic scapholunate gap improved postoperatively in all groups that reported pre- and postintervention (ES = 2.2-1.9 mm; OC = 2.5-1.8 mm) and slightly worsened in the NT group (2.5-2.7 mm). In the ES group, there were three complications (11.5%, no major complications), in the AC group there was one major complication (0.9%, complex regional pain syndrome [CRPS]), and in the OC group there were six complications (15.4%, four major complications-CRPS). Conclusion All interventional treatment options (ES, AC, and OC) provided significant improvements in patient-reported pain, range of motion, grip strength, and radiographic parameters, with low complication rates. In comparison, no improvement in range of motion or grip strength was noted in the NT group. Therefore, surgical management of pSLIL injuries is an effective and relatively safe treatment option. Further studies comparing the outcomes of specific surgical treatments are warranted to further elucidate the optimal management option for pSLIL tears. Level of Evidence Level III, systematic review of Level III-IV studies.

SUBMITTER: Lameire DL

PROVIDER: S-EPMC11254481 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options.

Lameire Darius Luke DL Khalik Hassaan Abdel HA Paul Ryan Augustine RA von Schroeder Herbert P HP Chan Andrea H W AHW

Journal of wrist surgery 20230412 4

<b>Purpose</b> This systematic review summarizes the existing evidence on treatment options and outcomes for partial scapholunate interosseous ligament (pSLIL) injuries. <b>Methods</b> A systematic electronic search of Medline, Embase, and CINAHL was performed from inception through to February 13, 2022. All primary research articles addressing the treatment of pSLIL tears were eligible for inclusion regardless of timing of surgery, surgical technique, or rehabilitation. The PRISMA Checklist g ...[more]

PMID: 39027024

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Project description:PurposeTreatment of subacute and chronic static scapholunate instability remains challenging. We aimed to determine 5- to 10-year outcomes of dorsal intercarpal ligament capsulodesis with scapholunate interosseous ligament repair for subacute and chronic static scapholunate instability.MethodsSix patients with subacute and chronic static scapholunate instability underwent dorsal intercarpal ligament capsulodesis with scapholunate interosseous ligament repair between 2011 and 2015, and 5 of them were followed for at least 5 years after surgery. The clinical and radiological results were retrospectively investigated. All patients were male, and the mean age at surgery was 37 years (range, 21-47 years). The mean period from injury to surgery was 26.2 months (range, 2-113 months). The surgical procedure was a modification of a method reported by Szabo et al.ResultsThe mean postoperative follow-up period was 8.1 years (range, 5.1-9.5 years). Median Disabilities of the Arm, Shoulder, and Hand and Mayo wrist scores improved from 23.3 to 1.7 and from 55 to 80, respectively, from before surgery to the final follow-up. Although the median flexion angle tended to be smaller, the median extension angle tended to be greater than before surgery. The median percent grip strength increased from 72.3% before surgery to 99.2% at the final follow-up. The median scapholunate gap improved from 4.2 mm before surgery to 2.1 mm at the final follow-up. The median scapholunate angle also improved from 95.7° before surgery to 71.3° at the final follow-up. Osteoarthritic changes were observed in 2 of 5 patients at the final follow-up.ConclusionsThe scapholunate gap in all patients was within the normal range after a mean of 8.1 years of follow-up. Dorsal intercarpal ligament capsulodesis with scapholunate interosseous ligament repair is considered a good alternative for subacute and chronic static scapholunate instability based on these 5- to 10-year outcomes.Type of study/level of evidenceTherapeutic IV.

Project description:BackgroundUlnar nerve injuries, especially high (proximal forearm) injuries, result in poor functional recovery. Peripheral nerve transfers have recently become a popular technique to augment nerve repairs and reduce the reinnervation distance before distal motor endplates irreversibly degenerate, leading to incomplete recovery.ObjectivesTo systematically review and analyse the recent literature regarding anterior interosseous nerve (AIN) to ulnar nerve transfers, including demographics, indications, outcomes, and complications.MethodsA search was performed using PubMed, MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases using the keywords ulnar nerve, ulnar nerve injury, ulnar motor nerve, anterior interosseous nerve, anterior interosseous, AIN, nerve transfer, and end-to-side using a 3-component search along with the Boolean operators 'AND' and 'OR'.ResultsA total of 341 studies were retrieved using the search criteria. Sixteen studies met the inclusion criteria including 12 retrospective case series, 3 retrospective cohort studies, and a single randomised control trial. Nine studies involved supercharged end-to-side transfer (SETS), 6 involved end-to-end transfer (ETE), and only 1 study compared results between SETS and ETE transfers. A total of 269 patients underwent nerve transfers. In the ETE subgroup, the average time to nerve transfer was 7 months, with a mean follow-up period of 24.5 months. Post-procedure, 100% (37/37) patients recovered intrinsic function of BMRC ≥1, and the average recovery time was 3.6 months. A total of 85% of patients recovered intrinsic function of BMRC ≥3. In the SETS group, the average time to nerve transfer was 2.5 months. The average follow-up in this cohort was 13.2 months. About 93% (145/156) recovered the intrinsic function of BMRC ≥1, and the average time to recovery was 7 months. About 75% of patients recovered the intrinsic function of BMRC ≥3 in their first dorsal interossei.ConclusionAIN to ulnar nerve transfer carries low morbidity, and there is low quality evidence to suggest recovery of intrinsic muscle function compared with conventional primary repair techniques. The supercharged end-to-side transfer (SETS) seems to be more favourable compared with end-to-side transfer. Outcome measurements are highly variable amongst studies, making standardisation difficult. Results of further trials are highly anticipated in this exciting field of peripheral nerve surgery.

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Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options.

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Partial Scapholunate Interosseous Ligament Injuries: A Systematic Review of Treatment Options.

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