Download PDF
J Wrist Surg 2016; 05(01): 059-066
DOI: 10.1055/s-0035-1570744
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

ScaphoLunate Axis Method

Jeffrey Yao
1   Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, California
,
Dan A. Zlotolow
2   Department of Orthopaedic Surgery, Philadelphia Shriners Hospital, Temple School of Medicine, Philadelphia, Pennsylvania
,
Steve K. Lee
3   Department of Orthopaedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
› Author Affiliations
Further Information

Publication History

01 June 2015

01 December 2015

Publication Date:
06 January 2016 (online)

   Permissions and Reprints

Corrected by:

ScaphoLunate Axis Method J Wrist Surg 2016; 05(02): 169-169
DOI: 10.1055/s-0036-1582009

Abstract

Background Treating chronic scapholunate ligament injuries without the presence of arthritis remains an unsolved clinical problem facing wrist surgeons. This article highlights a technique for reconstructing the scapholunate ligament using novel fixation, the ScaphoLunate Axis Method (SLAM).

Materials and Methods In a preliminary review of the early experience of this technique, 13 patients were evaluated following scapholunate ligament reconstruction utilizing the SLAM technique.

Description of Techinque The scapholunate interval is reconstructed utilizing a palmaris longus autograft passed between the scaphoid and lunate along the axis of rotation in the sagittal plane. It is secured in the lunate using a graft anchor and in the scaphoid utilizing an interference screw. The remaining graft is passed dorsally to reconstruct the dorsal scapholunate ligament.

Results At an average follow-up of 11 months, the mean postoperative scapholunate gap was 2.1 mm. The mean postoperative scapholunate angle was 59 degrees. The mean postoperative wrist flexion and extension was 45 and 56 degrees, respectively. The mean grip strength was 24.9 kg, or 62% of the contralateral side. The mean pain score (VAS) was 1.7. There was 1 failure with recurrence of the pathologic scapholunate gap and the onset of pain.

Conclusion While chronic scapholunate ligament instability remains an unsolved problem facing wrist surgeons, newer techniques are directed toward restoring the normal relationships of the scaphoid and lunate in both the coronal and sagittal planes. The SLAM technique has demonstrated promise in preliminary clinical studies.

Keywords

scapholunate - ligament - scapholunate ligament - scapholunate axis method
 

  • References

  • 1 Kuo CE, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2008; 33 (6) 998-1013
    CrossrefPubMedGoogle 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 Palmer AK, Dobyns JH, Linscheid RL. Management of post-traumatic instability of the wrist secondary to ligament rupture. J Hand Surg Am 1978; 3 (6) 507-532
    CrossrefPubMedGoogle Scholar
  • 4 Conyers DJ. Scapholunate interosseous reconstruction and imbrication of palmar ligaments. J Hand Surg Am 1990; 15 (5) 690-700
    CrossrefPubMedGoogle Scholar
  • 5 Lavernia CJ, Cohen MS, Taleisnik J. Treatment of scapholunate dissociation by ligamentous repair and capsulodesis. J Hand Surg Am 1992; 17 (2) 354-359
    CrossrefPubMedGoogle Scholar
  • 6 Gajendran VK, Peterson B, Slater Jr RR, Szabo RM. Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation. J Hand Surg Am 2007; 32 (9) 1323-1333
    CrossrefPubMedGoogle Scholar
  • 7 Glickel SZ, Millender LH. Ligamentous reconstruction for chronic intercarpal instability. J Hand Surg Am 1984; 9 (4) 514-527
    CrossrefPubMedGoogle Scholar
  • 8 Rosenwasser MP, Miyasajsa KC, Strauch RJ. The RASL procedure: reduction and association of the scaphoid and lunate using the Herbert screw. Tech Hand Up Extrem Surg 1997; 1 (4) 263-272
    CrossrefPubMedGoogle Scholar
  • 9 Bloom HT, Freeland AE, Bowen V, Mrkonjic L. The treatment of chronic scapholunate dissociation: an evidence-based assessment of the literature. Orthopedics 2003; 26 (2) 195-203 , quiz 204–205
    PubMedGoogle Scholar
  • 10 Kleinman WB, Carroll IV C. Scapho-trapezio-trapezoid arthrodesis for treatment of chronic static and dynamic scapho-lunate instability: a 10-year perspective on pitfalls and complications. J Hand Surg Am 1990; 15 (3) 408-414
    CrossrefPubMedGoogle Scholar
  • 11 Lee SK, Desai H, Silver B, Dhaliwal G, Paksima N. Comparison of radiographic stress views for scapholunate dynamic instability in a cadaver model. J Hand Surg Am 2011; 36 (7) 1149-1157
    CrossrefPubMedGoogle Scholar
  • 12 Garcia-Elias M, Lluch AL, Stanley JK. Three-ligament tenodesis for the treatment of scapholunate dissociation: indications and surgical technique. J Hand Surg Am 2006; 31 (1) 125-134
    CrossrefPubMedGoogle Scholar
  • 13 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
  • 14 Weiss AP. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (2) 205-215
    CrossrefPubMedGoogle Scholar
  • 15 Hom S, Ruby LK. Attempted scapholunate arthrodesis for chronic scapholunate dissociation. J Hand Surg Am 1991; 16 (2) 334-339
    PubMedGoogle Scholar
  • 16 Aviles AJ, Lee SK, Hausman MR. Arthroscopic reduction-association of the scapholunate. Arthroscopy 2007; 23 (1) 105.e1-105.e5
    PubMedGoogle Scholar
  • 17 Moran SL, Cooney WP, Berger RA, Strickland J. Capsulodesis for the treatment of chronic scapholunate instability. J Hand Surg Am 2005; 30 (1) 16-23
    CrossrefPubMedGoogle Scholar
  • 18 Brunelli GA, Brunelli GR. A new technique to correct carpal instability with scaphoid rotary subluxation: a preliminary report. J Hand Surg Am 1995; 20 (3, Pt 2) S82-S85
    CrossrefPubMedGoogle Scholar
  • 19 Chabas JF, Gay A, Valenti D, Guinard D, Legre R. Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients. J Hand Surg Am 2008; 33 (9) 1469-1477
    CrossrefPubMedGoogle Scholar
  • 20 Van Den Abbeele KL, Loh YC, Stanley JK, Trail IA. Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg [Br] 1998; 23 (2) 258-261
    CrossrefPubMedGoogle Scholar
  • 21 Moran SL, Ford KS, Wulf CA, Cooney WP. Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability. J Hand Surg Am 2006; 31 (9) 1438-1446
    CrossrefPubMedGoogle Scholar
  • 22 Fortin PT, Louis DS. Long-term follow-up of scaphoid-trapezium-trapezoid arthrodesis. J Hand Surg Am 1993; 18 (4) 675-681
    CrossrefPubMedGoogle Scholar
  • 23 Armstrong GW. Rotational subluxation of the scaphoid. Can J Surg 1968; 11 (3) 306-314
    PubMedGoogle Scholar
  • 24 Hastings DE, Silver RL. Intercarpal arthrodesis in the management of chronic carpal instability after trauma. J Hand Surg Am 1984; 9 (6) 834-840
    CrossrefPubMedGoogle Scholar
  • 25 Russell TB. Inter-carpal dislocations and fracture-dislocations; a review of 59 cases. J Bone Joint Surg Br 1949; 31B (4) 524-531 , illust
    PubMedGoogle Scholar
  • 26 Crisco JJ, Heard WM, Rich RR, Paller DJ, Wolfe SW. The mechanical axes of the wrist are oriented obliquely to the anatomical axes. J Bone Joint Surg Am 2011; 93 (2) 169-177
    CrossrefPubMedGoogle Scholar
  • 27 Pollock PJ, Sieg RN, Baechler MF, Scher D, Zimmerman NB, Dubin NH. Radiographic evaluation of the modified Brunelli technique versus the Blatt capsulodesis for scapholunate dissociation in a cadaver model. J Hand Surg Am 2010; 35 (10) 1589-1598
    CrossrefPubMedGoogle Scholar
  • 28 Lee SK, Zlotolow DA, Sapienza A, Karia R, Yao J. Biomechanical comparison of 3 methods of scapholunate ligament reconstruction. J Hand Surg Am 2014; 39 (4) 643-650
    CrossrefPubMedGoogle Scholar