DRAW Technique: An Arthroscopic-Assisted Minimal Invasive Method for the Reconstruction of the Scapholunate Ligament Using a Bone-Ligament-Bone Graft

Objective: The treatment of scapholunate dissociation is a challenging problem. The surgical strategy depends on chronologic and anatomic factors. The trophic condition of the scapholunate (SL) ligament is strictly correlated to the time between the trauma and diagnosis. The wrist's condition (presence of arthrosis and anatomic congruence) and the characteristic of the instability (possible reduction of the dorsal intercalated segment instability [DISI] and the rotatory subluxation of the scaphoid) must be evaluated before performing any surgical procedures. In literature there are different and various techniques of reconstruction of the SL ligament, but all techniques have some complications where stiffness is often present despite a perfect reconstruction of the ligament. From the experiences of open surgery of the wrist arises the new idea to convert the bone-ligament-bone reconstruction of the SL ligament by an arthroscopic method.

Methods: The concepts of “biologic surgery” and “minimally invasive surgery” inspired us to find a new method of reconstruction of the SL ligament with the conviction that preservation of the vascularization and proprioceptive innervation of the wrist would improve the outcomes. The authors present their new, personal and reproducible technique using bone-ligament-bone graft by arthroscopic method.

Results: On the basis of our preliminary experience, with 20 cases treated and with a minimum follow-up of 2 years, the advantages are undeniable. The results were assessed with the use of pre- and postoperative clinical and radiographic studies, and measurements of active and passive range of motion (preop average extension 59.9°, postop 61.7°; preop average flex 63.2°, postop 55.4°), grip strength, pulp and key pinch strength (preop 13.95 kg; postop 19.98), and a validated functional test (PHWRL preop 56.25; postop 22.6).

Conclusions: The results lead us to an optimistic judgment of this new technical possibility.