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J Wrist Surg
DOI: 10.1055/a-2803-5498
Survey or Meta-Analysis

Outcomes of Chronic Scapholunate Ligament Instability Surgery: A Meta-Synthesis

Authors

  • Nayeem Z. Hali

    1   Department of Trauma and Orthopaedics, Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom

  • Omar E. S. Mostafa 

    2   Birmingham Orthopaedic Training Programme (BOTP), The Knowledge Hub, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, United Kingdom

  • Safina Begum

    1   Department of Trauma and Orthopaedics, Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom

  • Shahbaz S. Malik

    1   Department of Trauma and Orthopaedics, Worcestershire Royal Hospital, Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom

  • Simon B. M. MacLean

    3   Department of Orthopaedic Surgery, Tauranga Hospital, Tauranga, New Zealand
    4   University of Auckland, Park Road, Auckland, New Zealand
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Abstract

Background

This review and meta-synthesis compare the radiographic and clinical outcomes of five surgical techniques for scapholunate ligament (SLL) injuries.

Materials and Methods

This study is reported using PRISMA and registered on the PROSPERO database. A literature search of four databases was performed on February 5, 2025. Comparative, single-arm, randomized, or nonrandomized studies that reported outcomes of surgical treatment for scapholunate instability in adult patients were included. Intervention groups were divided into five categories (capsulodesis, tendon graft, tenodesis, adjunct, and bone-ligament-bone [BLB] graft). Our primary outcome was the improvement in postoperative radiographic and clinical parameters. Our secondary outcomes were the incidence of complications across all groups. Subgroup analysis was performed based on the intervention to compare cumulative means. Statistical analysis was performed using R Studio. Risk of Bias assessed using the Newcastle–Ottawa Score.

Results

Twenty-nine studies were included with a total of 881 patients; of which 496 (56%) were males, with a mean age of 37.6 years (17–49), and a mean follow-up period of 67.5 months (14–141.6). There was an improvement in cumulative SL angles postoperatively across all groups, but only capsulodesis, BLB graft, and adjunct groups demonstrated a reduction to normal ranges. There was no demonstrated restoration of normal SL interval either cumulatively or in individual groups. There was an improvement in cumulative disability of arm, shoulder, and hand (DASH) and patient-rated wrist evaluation (PRWE) scores postoperatively; the largest improvement in postoperative PRWE and DASH scores was observed in the tendon graft. Complications were reported in 16% of patients (n = 141) across all studies. The commonest complication reported was progression of scapholunate advanced collapse arthritis in 6.5% of cases (n = 57). The BLB graft group had the commonest reported rate of complications at 4.9% (n = 43). Most studies had a moderate risk of bias.

Conclusion

Surgery for chronic SLL instability improves subjective functional scores with low rates of complications and re-operations, but may not restore normal static SL diastasis. Capsulodesis, BLB graft, and adjunct techniques may improve SL angles.

Keywords

scapholunate - ligament - reconstruction - outcomes


Publication History

Received: 04 August 2025

Accepted: 03 February 2026

Article published online:
27 February 2026

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