Download PDF
J Wrist Surg 2018; 07(04): 324-330
DOI: 10.1055/s-0038-1660446
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Arthroscopic Dorsal Capsuloplasty in Scapholunate Tears EWAS 3: Preliminary Results after a Minimum Follow-up of 1 Year

Benjamin Degeorge
1   Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
,
Rémy Coulomb
1   Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
,
Pascal Kouyoumdjian
1   Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
,
Olivier Mares
1   Département de Chirurgie Orthopédique et Traumatologique, Chirurgie du Rachis, CHU Carémeau, Nîmes, France
› Author Affiliations Funding None.
Further Information

Publication History

27 August 2017

23 April 2018

Publication Date:
08 June 2018 (online)

   Permissions and Reprints

Abstract

Purpose We retrospectively evaluated the results of all arthroscopic dorsal scapholunate (SL) capsuloplasty without pinning in patients presenting predynamic instability and dorsal capsuloscapholunate septum lesions on arthro–computed tomography scan after failed medical treatment.

Materials and Methods Fifteen patients, mean age 34.3 years, underwent all arthroscopically assisted dorsal capsuloplasty. Patients were assessed preoperatively and postoperatively by a clinical (pain, Watson's test, range of motion, and strength), functional (quick disabilities of the arm, shoulder, and hand), patient-rated wrist evaluation, and Mayo wrist score scores), and radiological (SL gap and dorsal intercalated segmental instability [DISI]) examination. SL tears were evaluated during surgery by European Wrist Arthroscopy Society (EWAS) classification.

Results The mean follow-up period was 20.2 months (range, 12–41). Preoperatively, positive Watson's test was noted in all cases. DISI deformity was noted in three cases without any SL gap. The SL instability was graded EWAS IIIB (n = 8) or EWAS IIIC (n = 7). Postoperatively, positive Watson's test was noted in only one case. Activity pain decreased from 7.8 preoperatively to 2.4 postoperatively. Range of motion in flexion–extension increased from 92.9 degrees preoperatively to 126.2 degrees postoperatively. Grip strength increased from 24.2 preoperatively to 38.2 postoperatively. At final follow-up, range of motion in flexion–extension and grip strength were estimated at 87 and 91% compared with contralateral side, respectively. All functional scores were significantly improved at the last follow-up. No radiographic SL gapping in grip views or DISI deformity was noted.

Discussion Cadaveric studies demonstrated that the dorsal portion of SL ligament is critical for the stability of the SL complex. The entire arthroscopic SL capsuloplasty technique provides reliable results for pain relief, avoiding postoperative stiffness associated with open procedures. It is an alternative technique for patients with predynamic SL instability after failure of medical management and shall not prelude the resort to any further open procedure.

Level of Evidence This is a level IV, case series.

Keywords

scapholunate ligament - dorsal capsuloplasty - dorsal - capsulodesis - wrist arthroscopy
 

  • References

  • 1 Kozin SH. The role of arthroscopy in scapholunate instability. Hand Clin 1999; 15 (03) 435-444
    Google Scholar
  • 2 O'Meeghan CJ, Stuart W, Mamo V, Stanley JK, Trail IA. The natural history of an untreated isolated scapholunate interosseus ligament injury. J Hand Surg [Br] 2003; 28 (04) 307-310
    CrossrefPubMedGoogle Scholar
  • 3 Pomeranz SJ, Salazar P. Scapholunate advanced collapse. J Surg Orthop Adv 2015; 24 (02) 140-143
    PubMedGoogle Scholar
  • 4 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of ligamentous stabilizers of the scaphoid and lunate. J Hand Surg Am 2002; 27 (06) 991-1002
    CrossrefPubMedGoogle Scholar
  • 5 Short WH, Werner FW, Green JK, Masaoka S. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part II. J Hand Surg Am 2005; 30 (01) 24-34
    CrossrefPubMedGoogle Scholar
  • 6 Short WH, Werner FW, Green JK, Sutton LG, Brutus JP. Biomechanical evaluation of the ligamentous stabilizers of the scaphoid and lunate: part III. J Hand Surg Am 2007; 32 (03) 297-309
    Google Scholar
  • 7 Mitsuyasu H, Patterson RM, Shah MA, Buford WL, Iwamoto Y, Viegas SF. The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability. J Hand Surg Am 2004; 29 (02) 279-288
    CrossrefPubMedGoogle Scholar
  • 8 Elsaidi GA, Ruch DS, Kuzma GR, Smith BP. Dorsal wrist ligament insertions stabilize the scapholunate interval: cadaver study. Clin Orthop Relat Res 2004; (425) 152-157
    PubMedGoogle Scholar
  • 9 Messina JC, Van Overstraeten L, Luchetti R, Fairplay T, Mathoulin CL. The EWAS classification of scapholunate tears: an anatomical arthroscopic study. J Wrist Surg 2013; 2 (02) 105-109
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Mathoulin C, Dauphin N, Sallen V. Arthroscopic dorsal capsuloplasty in chronic scapholunate ligament tears: a new procedure; preliminary report. Chir Main 2011; 30 (03) 188-197
    CrossrefPubMedGoogle Scholar
  • 11 Mathoulin CL, Dauphin N, Wahegaonkar AL. Arthroscopic dorsal capsuloligamentous repair in chronic scapholunate ligament tears. Hand Clin 2011; 27 (04) 563-572
    CrossrefPubMedGoogle Scholar
  • 12 Binder AC, Kerfant N, Wahegaonkar AL, Tandara AA, Mathoulin CL. Dorsal wrist capsular tears in association with scapholunate instability: results of an arthroscopic dorsal capsuloplasty. J Wrist Surg 2013; 2 (02) 160-167
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Wahegaonkar AL, Mathoulin CL. Arthroscopic dorsal capsulo-ligamentous repair in the treatment of chronic scapho-lunate ligament tears. J Wrist Surg 2013; 2 (02) 141-148
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Watson HK, Weinzweig J, Zeppieri J. The natural progression of scaphoid instability. Hand Clin 1997; 13 (01) 39-49
    Google Scholar
  • 15 Salvà-Coll G, Garcia-Elias M, Llusá-Pérez M, Rodríguez-Baeza A. The role of the flexor carpi radialis muscle in scapholunate instability. J Hand Surg Am 2011; 36 (01) 31-36
    Google Scholar
  • 16 León-López MM, García-Elías M, Salvà-Coll G, Llusá-Perez M, Lluch-Bergadà A. [Muscular control of scapholunate instability. An experimental study]. Rev Esp Cir Ortop Traumatol 2014; 58 (01) 11-18
    PubMedGoogle Scholar
  • 17 Watson HK, Ashmead IV D, Makhlouf MV. Examination of the scaphoid. J Hand Surg Am 1988; 13 (05) 657-660
    CrossrefPubMedGoogle Scholar
  • 18 MacDermid JC, Turgeon T, Richards RS, Beadle M, Roth JH. Patient rating of wrist pain and disability: a reliable and valid measurement tool. J Orthop Trauma 1998; 12 (08) 577-586
    CrossrefPubMedGoogle Scholar
  • 19 Jester A, Harth A, Wind G, Germann G, Sauerbier M. Disabilities of the arm, shoulder and hand (DASH) questionnaire: determining functional activity profiles in patients with upper extremity disorders. J Hand Surg [Br] 2005; 30 (01) 23-28
    CrossrefPubMedGoogle Scholar
  • 20 Cooney WP, Bussey R, Dobyns JH, Linscheid RL. Difficult wrist fractures. Perilunate fracture-dislocations of the wrist. Clin Orthop Relat Res 1987; (214) 136-147
    PubMedGoogle Scholar
  • 21 Moneim MS. The tangential posteroanterior radiograph to demonstrate scapholunate dissociation. J Bone Joint Surg Am 1981; 63 (08) 1324-1326
    CrossrefPubMedGoogle Scholar
  • 22 Schimmerl-Metz SM, Metz VM, Totterman SM, Mann FA, Gilula LA. Radiologic measurement of the scapholunate joint: implications of biologic variation in scapholunate joint morphology. J Hand Surg Am 1999; 24 (06) 1237-1244
    CrossrefPubMedGoogle Scholar
  • 23 Gilula LA, Weeks PM. Post-traumatic ligamentous instabilities of the wrist. Radiology 1978; 129 (03) 641-651
    CrossrefPubMedGoogle Scholar
  • 24 Eschweiler J, Stromps JP, Rath B, Pallua N, Radermacher K. Analysis of wrist bone motion before and after SL-ligament resection. Biomed Tech (Berl) 2016; 61 (03) 345-357
    CrossrefPubMedGoogle Scholar
  • 25 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 (05) 953-962
    CrossrefPubMedGoogle Scholar
  • 26 Short WH, Werner FW, Fortino MD, Palmer AK, Mann KA. A dynamic biomechanical study of scapholunate ligament sectioning. J Hand Surg Am 1995; 20 (06) 986-999
    CrossrefPubMedGoogle Scholar
  • 27 Kitay A, Wolfe SW. Scapholunate instability: current concepts in diagnosis and management. J Hand Surg Am 2012; 37 (10) 2175-2196
    CrossrefPubMedGoogle Scholar
  • 28 Berger RA. The gross and histologic anatomy of the scapholunate interosseous ligament. J Hand Surg Am 1996; 21 (02) 170-178
    CrossrefPubMedGoogle Scholar
  • 29 Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg Am 1999; 24 (03) 456-468
    PubMedGoogle Scholar
  • 30 Salva-Coll G, Garcia-Elias M, Hagert E. Scapholunate instability: proprioception and neuromuscular control. J Wrist Surg 2013; 2 (02) 136-140
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Overstraeten LV, Camus EJ, Wahegaonkar A. , et al. Anatomical description of the dorsal capsulo-scapholunate septum (DCSS)-arthroscopic staging of scapholunate instability after DCSS sectioning. J Wrist Surg 2013; 2 (02) 149-154
    Google Scholar
  • 32 Van Overstraeten L, Camus EJ. The role of extrinsic ligaments in maintaining carpal stability - a prospective statistical analysis of 85 arthroscopic cases. Hand Surg Rehabil 2016; 35 (01) 10-15
    Google Scholar
  • 33 Van Overstraeten L, Camus EJ. A systematic method of arthroscopic testing of extrinsic carpal ligaments: implication in carpal stability. Tech Hand Up Extrem Surg 2013; 17 (04) 202-206
    CrossrefPubMedGoogle Scholar
  • 34 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 (01) 125-134
    CrossrefPubMedGoogle Scholar
  • 35 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
    CrossrefPubMedGoogle Scholar
  • 36 Zarkadas PC, Gropper PT, White NJ, Perey BH. A survey of the surgical management of acute and chronic scapholunate instability. J Hand Surg Am 2004; 29 (05) 848-857
    CrossrefPubMedGoogle Scholar
  • 37 Tan SW, Ng SW, Tan SH, Teoh LC. Arthroscopic debridement of intercarpal ligament and triangular fibrocartilage complex tears. Singapore Med J 2012; 53 (03) 188-191
    PubMedGoogle Scholar
  • 38 Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am 1997; 22 (02) 344-349
    CrossrefPubMedGoogle Scholar