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J Wrist Surg 2015; 04(04): 230-238
DOI: 10.1055/s-0035-1556866
Special Focus Section: Scapholunate Ligament Reconstruction
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Outcomes of Capitohamate Bone-Ligament-Bone Grafts for Scapholunate Injury

Robert J. van Kampen
1   Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota
,
Christopher O. Bayne
2   Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
,
Steven L. Moran
3   Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
,
Richard A. Berger
4   Division of Hand Surgery, Department of Orthopedics Surgery, Mayo Clinic, Rochester, Minnesota
› Author Affiliations
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Publication History

Publication Date:
29 October 2015 (online)

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Abstract

Purpose In an attempt to restore natural carpal kinematics more closely, bone-ligament-bone (BLB) grafts have been described for treating scapholunate (SL) injury. In this article we report the long-term results of capitohamate BLB autograft for the treatment of SL dissociation.

Methods The medical records of patients treated with capitohamate BLB grafts for SL dissociation were retrospectively reviewed. Twenty-three patients were available for evaluation. Patients were sent a Disabilities of the Arm, Shoulder, and Hand (DASH) and a Patient-Rated Wrist Evaluation (PRWE) questionnaire and returned for exam. Thirteen patients returned the questionnaire, and 12 wrists were examined. Range of motion, grip strength, pain, complications, return to work, and radiographic parameters were documented.

Results The average length of follow-up evaluation was 9.2 years. The average SL gap was 4.5 mm preoperatively and 3.6 mm at final follow-up. The average SL angle was 70 degrees preoperatively and 73 degrees at final follow-up. There was no statistically significant difference in preoperative versus postoperative flexion, extension, radial deviation, ulnar deviation, or grip strength. The average postoperative visual analog scale (VAS) score was 1.25 at rest and 3.58 with activity. The average Mayo Wrist Score was 66.8 preoperatively and 70.9 postoperatively (p = 0.158). The average postoperative PRWE was 20.5, and average postoperative DASH was 15.1. At final follow-up, four patients had no radiographic evidence of arthritis. Two patients had evidence of early-stage radiocarpal arthritis, four had evidence of midcarpal arthritis, and two had radiographic evidence of mild scaphotrapeziotrapezoid arthritis. One patient required a salvage procedure with four-corner fusion.

Discussion BLB reconstruction can be used to treat SL instability. At final follow-up, the majority of patients did not worsen clinically or functionally or require secondary salvage procedures; however, radiologic progression of arthritis was not prevented. These outcomes are comparable to midterm results of other SL reconstructive options; thus, we have abandoned this technique for other less technically demanding procedures.

Level of Evidence IV

Keywords

bone-ligament-bone reconstruction - scapholunate instability - scapholunate injury - wrist pain
 

  • References

  • 1 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
  • 2 Mayfield JK. Mechanism of carpal injuries. Clin Orthop Relat Res 1980; (149) 45-54
    PubMedGoogle 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 Weiss APC, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am 1997; 22 (2) 344-349
    CrossrefPubMedGoogle Scholar
  • 5 Ruch DS, Poehling GG. Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist. J Hand Surg Am 1996; 21 (3) 412-417
    CrossrefPubMedGoogle Scholar
  • 6 Whipple TL. The role of arthroscopy in the treatment of scapholunate instability. Hand Clin 1995; 11 (1) 37-40
    Google Scholar
  • 7 Darlis NA, Kaufmann RA, Giannoulis F, Sotereanos DG. Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability. J Hand Surg Am 2006; 31 (3) 418-424
    CrossrefPubMedGoogle Scholar
  • 8 Walsh JJ, Berger RA, Cooney WP. Current status of scapholunate interosseous ligament injuries. J Am Acad Orthop Surg 2002; 10 (1) 32-42
    CrossrefPubMedGoogle Scholar
  • 9 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
  • 10 Almquist EE, Bach AW, Sack JT, Fuhs SE, Newman DM. Four-bone ligament reconstruction for treatment of chronic complete scapholunate separation. J Hand Surg Am 1991; 16 (2) 322-327
    CrossrefPubMedGoogle Scholar
  • 11 Brunelli GA, Brunelli GR. A new surgical technique for carpal instability with scapholunate dissociation. Surg Technol Int 1996; 5: 370-374
    PubMedGoogle Scholar
  • 12 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
  • 13 Viegas SF, Dasilva MF. Surgical repair for scapholunate dissociation. Tech Hand Up Extrem Surg 2000; 4 (3) 148-153
    CrossrefPubMedGoogle Scholar
  • 14 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
  • 15 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
  • 16 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
  • 17 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
  • 18 Muermans S, De Smet L, Van Ransbeeck H. Blatt dorsal capsulodesis for scapholunate instability. Acta Orthop Belg 1999; 65 (4) 434-439
    PubMedGoogle Scholar
  • 19 Szabo RM, Slater Jr RR, Palumbo CF, Gerlach T. Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results. J Hand Surg Am 2002; 27 (6) 978-984
    CrossrefPubMedGoogle Scholar
  • 20 Wyrick JD, Youse BD, Kiefhaber TR. Scapholunate ligament repair and capsulodesis for the treatment of static scapholunate dissociation. J Hand Surg [Br] 1998; 23 (6) 776-780
    CrossrefPubMedGoogle Scholar
  • 21 Talwalkar SC, Edwards ATJ, Hayton MJ, Stilwell JH, Trail IA, Stanley JK. Results of tri-ligament tenodesis: a modified Brunelli procedure in the management of scapholunate instability. J Hand Surg [Br] 2006; 31 (1) 110-117
    CrossrefPubMedGoogle Scholar
  • 22 Cuénod P. Osteoligamentoplasty and limited dorsal capsulodesis for chronic scapholunate dissociation. Ann Chir Main Memb Super 1999; 18 (1) 38-53
    PubMedGoogle Scholar
  • 23 Cuénod P, Charrière E, Papaloïzos MY. A mechanical comparison of bone-ligament-bone autografts from the wrist for replacement of the scapholunate ligament. J Hand Surg Am 2002; 27 (6) 985-990
    CrossrefPubMedGoogle Scholar
  • 24 Weiss APC. Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft. J Hand Surg Am 1998; 23 (2) 205-215
    CrossrefPubMedGoogle Scholar
  • 25 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
  • 26 Harvey EJ, Hanel D, Knight JB, Tencer AF. Autograft replacements for the scapholunate ligament: a biomechanical comparison of hand-based autografts. J Hand Surg Am 1999; 24 (5) 963-967
    CrossrefPubMedGoogle Scholar
  • 27 Harvey EJ, Hanel DP. Bone-ligament-bone reconstruction for scapholunate disruption. Tech Hand Up Extrem Surg 2002; 6 (1) 2-5
    CrossrefPubMedGoogle Scholar
  • 28 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
  • 29 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
  • 30 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
  • 31 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
  • 32 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
  • 33 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
  • 34 Amadio PC, Berquist TH, Smith DK, Ilstrup DM, Cooney III WP, Linscheid RL. Scaphoid malunion. J Hand Surg Am 1989; 14 (4) 679-687
    CrossrefPubMedGoogle Scholar
  • 35 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
  • 36 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
  • 37 Geissler WB, Freeland AE, Savoie FH, McIntyre LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. J Bone Joint Surg Am 1996; 78 (3) 357-365
    CrossrefPubMedGoogle Scholar
  • 38 Gay AM, Thoreson A, Berger RA. Biomechanical comparison of the hand-based transplant used in bone-tissue-bone scapho-lunate ligament reconstruction. Chir Main 2014; 33 (1) 23-28
    CrossrefPubMedGoogle Scholar
  • 39 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