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J Wrist Surg 2023; 12(03): 248-260
DOI: 10.1055/s-0042-1758159
Emerging Technologies and New Technological Concepts

Evaluation of Scapholunate Injury and Repair with Dynamic (4D) CT: A Preliminary Report of Two Cases

Taylor P. Trentadue 
1   Mayo Clinic Medical Scientist Training Program and Mayo Clinic Graduate Program in Biomedical Engineering and Physiology, Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
,
Cesar Lopez
2   Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
,
Ryan E. Breighner
3   Department of Radiology and Imaging, Hospital for Special Surgery, New York, New York
,
Kalli Fautsch
2   Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
,
Shuai Leng
4   Computed Tomography Clinical Innovation Center, Mayo Clinic, Rochester, Minnesota
,
David R. Holmes III
5   Biomedical Imaging Resource Division, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
,
Steven L. Moran
6   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Andrew R. Thoreson
2   Assistive and Restorative Technology Laboratory, Mayo Clinic, Rochester, Minnesota
,
Sanjeev Kakar
6   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Kristin D. Zhao
7   Assistive and Restorative Technology Laboratory, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
› Author Affiliations Funding None.
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Abstract

Background In predynamic or dynamic scapholunate (SL) instability, standard diagnostic imaging may not identify SL interosseous ligament (SLIL) injury, leading to delayed detection and intervention. This study describes the use of four-dimensional computed tomography (4DCT) in identifying early SLIL injury and following injured wrists to 1-year postoperatively.

Description of Technique 4DCT acquires a series of three-dimensional volume data with high temporal resolution (66 ms). 4DCT-derived arthrokinematic data can be used as biomarkers of ligament integrity.

Patients and Methods This study presents the use of 4DCT in a two-participant case series to assess changes in arthrokinematics following unilateral SLIL injury preoperatively and 1-year postoperatively. Patients were treated with volar ligament repair with volar capsulodesis and arthroscopic dorsal capsulodesis. Arthrokinematics were compared between uninjured, preoperative injured, and postoperative injured (repaired) wrists.

Results 4DCT detected changes in interosseous distances during flexion-extension and radioulnar deviation. Generally, radioscaphoid joint distances were greatest in the uninjured wrist during flexion-extension and radioulnar deviation, and SL interval distances were smallest in the uninjured wrist during flexion-extension and radioulnar deviation.

Conclusion 4DCT provides insight into carpal arthrokinematics during motion. Distances between the radioscaphoid joint and SL interval can be displayed as proximity maps or as simplified descriptive statistics to facilitate comparisons between wrists and time points. These data offer insight into areas of concern for decreased interosseous distance and increased intercarpal diastasis. This method may allow surgeons to assess whether (1) injury can be visualized during motion, (2) surgery repaired the injury, and (3) surgery restored normal carpal motion.

Level of Evidence Level IV, Case series.

Keywords

four-dimensional computed tomography - scapholunate - scapholunate interosseous ligament - wrist arthrokinematics - wrist biomechanics

Ethical Review Committee Statement

This study was approved by the Institutional Review Board (IRB) at the Mayo Clinic in Rochester, Minnesota, USA.


A Statement of the Location where the Work was Performed (Only if Authors from Multiple Institutions)

All data were collected at the Mayo Clinic, Rochester, Minnesota, USA.


Supplementary Material



Publication History

Received: 30 November 2021

Accepted: 15 September 2022

Article published online:
09 February 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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