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Arthroscopic Scapholunate Synthetic Ligamentoplasty.

ABSTRACT: The scapholunate ligament is made of 3 portions: proximal, volar, and dorsal. The latter is the major stabilizer of the scapholunar pair, and its lesion is bound to cause a destabilization of the carpus, as well as scapholunar diastasis, dorsal intercalated segment instability, then eventually SLAC (i.e., scapholunate advanced collapse) wrist. The healing process of this ligament, either spontaneous or after primary repair with direct suture, is rarely observed and a significant number of patients are diagnosed only at a late stage, thus making an illusion of a maintained stability of the carpus first range. Management then consists of ligamentoplasty. Several open techniques are described to restore stability, but at the cost of a frequent and significant tightening of the wrist. We will introduce here an arthroscopic ligamentoplasty technique completed by a posterior capsulodesis.

SUBMITTER: Bouyer M

PROVIDER: S-EPMC8417514 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Arthroscopic Scapholunate Synthetic Ligamentoplasty.

Bouyer Michael M Lafosse Thibault T Bentejac Antonin A

Arthroscopy techniques 20210828 9

The scapholunate ligament is made of 3 portions: proximal, volar, and dorsal. The latter is the major stabilizer of the scapholunar pair, and its lesion is bound to cause a destabilization of the carpus, as well as scapholunar diastasis, dorsal intercalated segment instability, then eventually SLAC (i.e., scapholunate advanced collapse) wrist. The healing process of this ligament, either spontaneous or after primary repair with direct suture, is rarely observed and a significant number of patien ...[more]

PMID: 34504760

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All-Dorsal Arthroscopic Ligamentoplasty (ADAL) in Scapholunate Instability Management: Surgical Technique.

Project description:In advanced scapholunate instability, a scapholunate repair by open or arthroscopic ligamentoplasty is indicated. Although the radiographic results and functional scores are more or less satisfactory for open ligamentoplasty, it is often responsible for a decrease in joint amplitude postoperatively. Arthroscopic techniques are therefore of great interest, since they respect the joint capsule, but they remain technically difficult and demanding surgeries, requiring a good deal of experience in arthroscopy and using bone tunnels that are potentially a source of complications, as well as pinning to the palmar side of the wrist, which is potentially dangerous for the palmar structures of the wrist. We present a surgical technique of scapholunate ligamentoplasty under arthroscopy, focusing only on the dorsal scapholunate complex: all-dorsal arthroscopic ligamentoplasty. The advantages of all-dorsal arthroscopic ligamentoplasty are that it requires little material, does away with palmar approaches, and focuses only on the dorsal side, simplifying surgery and avoiding the creation of bone tunnels potentially at risk of fracture or avascular necrosis.

| S-EPMC10627966 | biostudies-literature

Arthroscopically Assisted Ligamentoplasty for Axial and Dorsal Reconstruction of the Scapholunate Ligament.

Project description:Scapholunate (SL) ligament injury is among the most common injuries of the intrinsic ligaments of the carpus. Arthroscopic treatment in complete and nonacute injuries has had poor results. These cases have typically been treated using open surgical techniques that require a broad dorsal approach and produce soft tissue impairment, which leads to reduced wrist mobility. The development of wrist arthroscopy techniques has allowed the treatment of complete and nonacute injuries of the SL ligament, without the disadvantages of open surgery, respecting the soft tissues and avoiding injury of the posterior interosseous nerve, in an attempt to preserve the proprioception of the wrist and the secondary dorsal stabilizers. This arthroscopically assisted technique reconstructs the SL ligament using a tendon graft placed between the scaphoid and lunate and complemented by the reconstruction of the dorsal portion of the SL ligament, with the aim of creating an axial and dorsal tendinous ligamentoplasty between both bones.

| S-EPMC4947964 | biostudies-literature

Indirect Scapholunate Ligament Repair: All Arthroscopic.

Project description:The arthroscopic technique most frequently used in acute scapholunate instability is reduction and fixation with Kirschner wires. To repair the injured ligament, open surgery and dorsal capsular plication are recommended, but this procedure has the risk of damaging secondary dorsal stabilizers, the dorsal blood supply, and the proprioceptive innervation of the posterior interosseous nerve. In this report, we present an all-arthroscopic technique of a dorsal reconstruction of the scapholunate interosseous ligament for scapholunate instability using a tape by tethering the scaphoid to the lunate.

| S-EPMC5984282 | biostudies-literature

Arthroscopic Scapholunate Capsuloligamentous Repair: Suture With Dorsal Capsular Reinforcement for Scapholunate Ligament Lesion.

Project description:Scapholunate ligament (SLL) injury is the most frequent injury of the intrinsic carpal ligaments. The dorsal part of the SLL is the most important part for the stability of the scapholunate joint, and tears of this part and at least one of its secondary capsular attachments cause scapholunate dissociation. The arthroscopic technique most frequently used for acute injuries is reduction and fixation with Kirschner wires, and techniques that involve a primary repair of the injured ligament are performed by open surgery with efficient results. However, they lead to significant stiffness of the wrist due to injury to the soft tissue caused by damage to the secondary dorsal stabilizers; the dorsal blood supply; and in many cases, the proprioceptive innervation of the posterior interosseous nerve. We present an all-arthroscopic technique for the direct repair of acute injuries of the dorsal part of the SLL using bone anchors, complemented by a dorsal arthroscopic plication that reconstructs the dorsal capsulo-scapholunate septum of the scapholunate complex.

| S-EPMC5368283 | biostudies-literature

Surgical Technique: Wide Arthroscopic Dorsal Capsuloligamentous Repair for Advanced Scapholunate Instability.

Project description:In the most advanced cases of scapholunate instability with dynamic or static signs, classical arthroscopic repair seems impossible. Ligamentoplasties or open surgery procedures are technically demanding, hampered by significant operative complications and often stiffening. Therapeutic simplification is therefore necessary for the management of these complex cases of advanced scapholunate instability. We propose a minimally invasive, reliable, and easily reproducible solution that requires little equipment other than arthroscopic material.

| S-EPMC10066428 | biostudies-literature

The EWAS Classification of Scapholunate Tears: An Anatomical Arthroscopic Study.

Project description:Treatment of scapho-lunate (SL) injuries is still a challenge for the surgeon, especially in chronic cases. The aim of the study isto experimentally cut, specific portions of scapholunate ligament and extrinsic ligaments and check their corresponding arthroscopic finding in order to understand the pathogenesis and develop a new classification system which is an evolution of the present arthroscopic classifications. Materials and Methods Thirteen cadaver wrists were studied under arthroscopy. Different portions of the scapho-lunate ligament were subsequently sectioned. In group A the sectioning sequence was: anterior SLIOL, RSC, LRL, SLIOL's proximal and posterior, DIC, DRC ligament and ST ligaments (8 cases). In group B it was: SLIOL's posterior and proximal, DIC, SLIOL's anterior, LRL, RSCL, DRC, ST ligaments (5 cases). The anatomo-pathological findings after each sectioning were correlated to the classification system proposed (Table 1). Results In group A, stage 3A was obtained when SL ligament's volar and intermediate portion and/ or SC/LRL ligaments were sectioned. A stage 3C was obtained when section of posterior SLIOL was sectioned as well. A stage IV when the DIC was also sectioned. In group B a stage 3B was obtained by cutting intermediate, posterior portion of the SLIOL ligament and DIC. A stage 3C was obtained when the anterior part of the SLIOL was also sectioned. In all cases, sectioning of the SLIOL lead to a stage 3C only if associated with sectioning of at least one of the extrinsic stabilizers (DIC or SC/LRL). Sectioning of DIC and SC ligament, in addition to SLIOL led to an arthroscopic stage IV. When ST, DRC and TH ligaments were also sectioned significant radiological signs appeared (stage V). Conclusions This study helps us to understand the anatomo-pathological scapho-lunate lesions in their different stages of partial lesions. Commonly called scapho-lunate lesions are complex, involving also extrinsic ligaments.

| S-EPMC3699273 | biostudies-other

Anatomical Description of the Dorsal Capsulo-Scapholunate Septum (DCSS)-Arthroscopic Staging of Scapholunate Instability after DCSS Sectioning.

Project description:Background The dorsal capsuloligamentous scapholunate septum (DCSS) is a confluence of the dorsal capsule, the dorsal intercarpal ligament (DIC), and the scapholunate interosseous ligament (SLIOL). It appears to play a role in the stability of the scapholunate articulation. The purpose of this study was to describe the anatomical basis for this structure and to investigate its role in scapholunate instability through sectioning of this structure followed by an arthroscopic and fluoroscopic analysis. Material and Methods In the anatomical part of the study we dissected 3 fresh cadaver wrists to examine the anatomy of the DCSS. In the arthroscopic part of the study we assessed the EWAS grade of SL instability before and after sectioning the DCSS and measured the scapholunate and radiolunate angles fluoroscopically. Results Sectioning the DCSS increased the EWAS grade of SL instability but did not affect the scapholunate gap, the scapholunate angle or radiolunate angle. Conclusion We have demonstrated that there is a distinct structure that is separate from the dorsal capsule, which we have labeled the Dorsal Capsuloligamentous Scapholunate Septum. We believe that the DCSS is a previously unreported secondary stabilizer of the SL joint which may have therapeutic and prognostic implications.

| S-EPMC3699264 | biostudies-other

Arthroscopic Volar Extrinsic Plicature of the Volar Extrinsic Ligaments for Chronic Volar Scapholunate Instability.

Project description:The scapholunate ligamentous complex consists of the scapholunate interosseous ligament and the surrounding extrinsic ligamentous system. In cases of chronic scapholunate instability, stabilizing the extrinsic ligaments is crucial. This article presents an arthroscopic capsuloligamentous reinforcement plicature that focuses on tightening the volar scapholunate extrinsic ligaments, namely the radioscaphocapitate ligament and long radiolunate ligament, along with indirect tightening of the volar scapholunate interosseous ligament. Although it may be challenging to differentiate the effect of the volar extrinsic plicature from a dorsal capsular reinforcement when both are applied, the volar extrinsic plicature can serve as a beneficial addition to dorsal capsular reinforcement techniques for complex scapholunate instability.

| S-EPMC11258700 | biostudies-literature

The floating lunate: arthroscopic treatment of simultaneous complete tears of the scapholunate and lunotriquetral ligaments.

Project description:Carpal instabilities continue to be a controversial topic in hand surgery. Accurate diagnosis of the ligament injuries is usually difficult without an arthroscopic evaluation. Few studies have focused on the diagnosis and proper management of simultaneous scapholunate (SL) and lunotriquetral (LT) ligament tears. This is an uncommon injury that leads to marked disability and chronic wrist pain. This is essentially a "floating lunate" and indicates a severe ligamentous lesion. Thirteen patients (six female and seven male) with complete SL and LT tears and with gross arthroscopic dynamic carpal instability were included in the present study. None of the patients showed radiographic evidence of lunate dislocation. One patient presented acutely and was operated on 3 days after the injury. The average time from the initial injury to the arthroscopy for the other 12 patients was 13.5 months (range 1.5-84 months). All patients underwent arthroscopic debridement of the SL and LT ligaments coupled with percutaneous pinning (two 0.045-in. Kirschner wires) in both joints. At the final follow-up, the average range of motion was 50 degrees of flexion, 54 degrees of extension, 77 degrees of pronation, 80 degrees of supination, 25 degrees of ulnar deviation, and 15 degrees of radial deviation. The average final grip strength was 67% from the non-affected side. All patients had negative shifting tests at final follow-up. Furthermore, there was no evidence of any static or dynamic instability in all the patients except for one patient who developed a volar intercalated segment instability 8 months after the surgery. At the final follow-up, ten patients had no pain, one had mild pain, and two experienced moderate pain.

| S-EPMC2724611 | biostudies-other

Anterior Shoulder Ligamentoplasty as a Treatment for Multidirectional Shoulder Instability.

Project description:Multidirectional shoulder instability represents an ongoing challenge for orthopaedic surgeons, and multiple techniques have been described to treat this condition. We present a modified anterior shoulder ligamentoplasty, in which we perform an inferior glenohumeral ligament (IHGL) anteroinferior and posteroinferior plication and, subsequently, an anterior reinforcement ligamentoplasty with an allograft through the subscapularis tendon, with humeral and glenoid fixation. This arthroscopic technique allows shoulder stability in the throwing position, as the humeral head is not uncovered in abduction, and external rotation by ascending the subscapularis tendon.

| S-EPMC9827029 | biostudies-literature

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