Download PDF
J Wrist Surg 2015; 04(04): 264-268
DOI: 10.1055/s-0035-1566268
Special Focus Section: Scapholunate Ligament Reconstruction
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reconstruction of the Scapholunate Ligament Using Capitohamate Bone-Ligament-Bone

Toshiyasu Nakamura
1   Department of Orthopaedic Surgery, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
,
Koji Abe
1   Department of Orthopaedic Surgery, International University of Health and Welfare, Sanno Hospital, Tokyo, Japan
,
Takuji Iwamoto
2   Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
,
Kensuke Ochi
2   Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
,
Kazuki Sato
2   Department of Orthopaedic Surgery, Keio University, Tokyo, Japan
› Author Affiliations
Further Information

Publication History

Publication Date:
29 October 2015 (online)

    Permissions and Reprints

Abstract

Background The biomechanical properties of the capitohamate (CH) ligament are equivalent to those of the scapholunate (SL) interosseous ligament. We reconstructed the SL ligament using the CH bone-ligament-bone substitute for chronic injury of the SL ligament.

Patients and Methods Beginning in 2008, 15 wrists of 14 patients with an average age of 38 years underwent this procedure with a minimum follow-up of 2 years. Thirteen wrists had an SL joint gap more than 3 mm, and two had a complete SL ligament disruption with a severe dorsal intercalated segment instability (DISI) deformity. Kirschner wires (K-wires) were removed 8 weeks after the surgery, then active ROM exercise began. Pain (on visual analog scale [VAS]), wrist motion (angle), radiographic characteristics, such as SL gap (mm) and SL angle, and Modified Mayo Wrist Score (MMWS) were evaluated.

Technique The SL joint was reduced by manipulation or with the use of joysticks, then temporary fixed with K-wires. A dorsal trough was then made between the scaphoid and the lunate. The proximal half of the CH ligament was harvested with attached bone from the capitate and hamate (CH bone-ligament-bone), inset into the SL trough, and fixed firmly with 1.2-mm diameter titanium screws in the scaphoid and lunate, respectively.

Results The VAS improved from 77 preoperatively to 12 postoperatively. The average wrist extension/flexion was 74°/60°. There was no ossification of the reconstructed SL at the final follow-up. The SL gap improved from an average of 4.8 mm to an average of 2.1 mm, and the SL angle changed from 67° to 55°. The MMWS improved to 82 points postoperatively from a preoperative average of 47 with eight excellent, five good, and two fair results.

Keywords

scapholunate ligament - capitohamate ligament - reconstruction - chronic injury
 

  • References

  • 1 Linscheid RL, Dobyns JH, Beabout JW, Bryan RS. Traumatic instability of the wrist. Diagnosis, classification, and pathomechanics. J Bone Joint Surg Am 1972; 54 (8) 1612-1632
    PubMedGoogle Scholar
  • 2 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (3) 358-365
    CrossrefPubMedGoogle Scholar
  • 3 Watson H, Ottoni L, Pitts EC, Handal AG. Rotary subluxation of the scaphoid: a spectrum of instability. J Hand Surg [Br] 1993; 18 (1) 62-64
    CrossrefPubMedGoogle Scholar
  • 4 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
    PubMedGoogle Scholar
  • 5 Brunelli GA, Brunelli GR. A new surgical technique for carpal instability with scapholunate dissociation. Surg Technol Int 1996; 5: 370-374
    PubMedGoogle Scholar
  • 6 Viegas SF, Dasilva MF. Surgical repair for scapholunate dissociation. Tech Hand Up Extrem Surg 2000; 4 (3) 148-153
    CrossrefPubMedGoogle Scholar
  • 7 Berger RA, Imeada T, Berglund L, An KN. Constraint and material properties of the subregions of the scapholunate interosseous ligament. J Hand Surg Am 1999; 24 (5) 953-962
    CrossrefPubMedGoogle Scholar
  • 8 Cuénod P. Osteoligamentoplasty and limited dorsal capsulodesis for chronic scapholunate dissociation. Ann Chir Main Memb Super 1999; 18 (1) 38-53
    PubMedGoogle Scholar
  • 9 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (2) 205-215
    CrossrefPubMedGoogle Scholar
  • 10 Soong M, Merrell GA, Ortmann IV F, Weiss AP. Long-term results of bone-retinaculum-bone autograft for scapholunate instability. J Hand Surg Am 2013; 38 (3) 504-508
    CrossrefPubMedGoogle Scholar
  • 11 Davis CA, Culp RW, Hume EL, Osterman AL. Reconstruction of the scapholunate ligament in a cadaver model using a bone-ligament-bone autograft from the foot. J Hand Surg Am 1998; 23 (5) 884-892
    CrossrefPubMedGoogle Scholar
  • 12 Harvey EJ, Hanel DP. Bone-ligament-bone reconstruction for scapholunate disruption. Tech Hand Up Extrem Surg 2002; 6 (1) 2-5
    CrossrefPubMedGoogle Scholar
  • 13 Hofstede DJ, Ritt MJ, Bos KE. Tarsal autografts for reconstruction of the scapholunate interosseous ligament: a biomechanical study. J Hand Surg Am 1999; 24 (5) 968-976
    CrossrefPubMedGoogle Scholar
  • 14 Müller M, Reik M, Sauerbier M, Germann G. A new bone-ligament-bone autograft from the plantar plates of the toes and its potential use in scapholunate reconstruction: an anatomical study. Ann Plast Surg 2008; 61 (4) 463-467
    CrossrefPubMedGoogle Scholar
  • 15 Svoboda SJ, Eglseder Jr WA, Belkoff SM. Autografts from the foot for reconstruction of the scapholunate interosseous ligament. J Hand Surg Am 1995; 20 (6) 980-985
    CrossrefPubMedGoogle Scholar
  • 16 Lutz M, Haid C, Steinlechner M , et al. Scapholunate ligament reconstruction using a periosteal flap of the iliac crest: a biomechanical study. Arch Orthop Trauma Surg 2004; 124 (4) 262-266
    CrossrefPubMedGoogle Scholar
  • 17 Ritt MJ, Berger RA, Bishop AT, An KN. The capitohamate ligaments. A comparison of biomechanical properties. J Hand Surg [Br] 1996; 21 (4) 451-454
    PubMedGoogle Scholar
  • 18 Ritt MJ, Berger RA, Kauer JM. The gross and histologic anatomy of the ligaments of the capitohamate joint. J Hand Surg Am 1996; 21 (6) 1022-1028
    CrossrefPubMedGoogle Scholar
  • 19 Berger RA, Bishop AT, Bettinger PC. New dorsal capsulotomy for the surgical exposure of the wrist. Ann Plast Surg 1995; 35 (1) 54-59
    CrossrefPubMedGoogle Scholar
  • 20 Kalb K, Prommersberger KJ. Treatment of chronic scapholunate dissociation using Cuénod's bone-ligament-bone autograft [in German]. Oper Orthop Traumatol 2009; 21 (4–5) 417-428
    CrossrefPubMedGoogle Scholar