Treatment of Chronic Scapholunate Dissociation with FCR Tenodesis: A Systematic Review of the Results of MBT and 3LT Technique

Abstract

A systematic literature review was performed to assess the results of modified Brunelli tenodesis modified Brunelli technique (MBT) and three-ligament tenodesis (3LT) in the treatment of chronic scapholunate (SL) ligament injuries reported between 1998 and 2001. This review describes the surgical techniques, clinical outcomes, radiological evaluations, and complication rates among 600 patients. Following adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 15 studies were included (289 MBT and 311 3LT procedures). A heterogeneity in surgical technique was noted. An average pain reduction of 3 points on the visual analog score and a flexion–extension arch compatible with most daily activities were found. Radiographic follow-up showed medium-term improvements, but loss of reduction was observed in the long term. Secondary degeneration was seen in 15% of cases. Radiographic decay did not correlate with clinical outcomes. The overall complication rate was 9%. This review underscores the satisfactory clinical outcome of both procedures. Nonetheless, both interventions pose risks of complications and/or degeneration in the long term.

Keywords

scapholunate instability - wrist - ligament injury - carpal instability

Authors' Contributions

This literature review and data collection were conducted by E.S., under the guidance of S.G., and N.v.B.S.G. is the first author of the manuscript.

Publication History

Received: 15 May 2024

Accepted: 09 October 2024

Article published online:
08 November 2024

• References

• 1 Mayfield JK. Mechanism of carpal injuries. Clin Orthop Relat Res 1980; 149 (149) 45-54
• 2 Wahed K, Deore S, Bhan K. et al. Management of chronic scapholunate ligament injury. J Clin Orthop Trauma 2020; 11 (04) 529-536
• 3 Watson HK, Ballet FL. The SLAC wrist: scapholunate advanced collapse pattern of degenerative arthritis. J Hand Surg Am 1984; 9 (03) 358-365
• 4 Athlani L, Pauchard N, Detammaecker R. et al. Treatment of chronic scapholunate dissociation with tenodesis: a systematic review. Hand Surg Rehabil 2018; 37 (02) 65-76
• 5 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
• 6 Van Den Abbeele KLS, Loh YC, Stanley JK, Trail IA. Early results of a modified Brunelli procedure for scapholunate instability. J Hand Surg [Br] 1998; 23 (02) 258-261
• 7 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
• 8 Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S. PICO, PICOS and SPIDER: a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. BMC Health Serv Res 2014; 14: 579
• 9 Links AC, Chin SH, Waitayawinyu T, Trumble TE. Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave. J Hand Surg Am 2008; 33 (06) 850-856
• 10 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 (09) 1438-1446
• 11 Rohman EM, Agel J, Putnam MD, Adams JE. Scapholunate interosseous ligament injuries: a retrospective review of treatment and outcomes in 82 wrists. J Hand Surg Am 2014; 39 (10) 2020-2026
• 12 De Smet L, Van Hoonacker P. Treatment of chronic static scapholunate dissociation with the modified Brunelli technique: preliminary results. Acta Orthop Belg 2007; 73 (02) 188-191
• 13 Ellanti P, Sisodia G, Al-Ajami A, Ellanti P, Harrington P. The modified Brunelli procedure for scapholunate instability: a single centre study. Hand Surg 2014; 19 (01) 39-42
• 14 Blackburn J, van der Oest MJW, Poelstra R, Selles RW, Chen NC, Feitz R. Hand-Wrist Study Group. Three-ligament tenodesis for chronic scapholunate injuries: short-term outcomes in 203 patients. J Hand Surg Eur Vol 2020; 45 (04) 383-388
• 15 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 (01) 110-117
• 16 Elgammal A, Lukas B. Mid-term results of ligament tenodesis in treatment of scapholunate dissociation: a retrospective study of 20 patients. J Hand Surg Eur Vol 2016; 41 (01) 56-63
• 17 Ryu JY, Cooney III WP, Askew LJ, An KN, Chao EYS. Functional ranges of motion of the wrist joint. J Hand Surg Am 1991; 16 (03) 409-419
• 18 Montgomery SJ, Rollick NJ, Kubik JF, Meldrum AR, White NJ. Surgical outcomes of chronic isolated scapholunate interosseous ligament injuries: a systematic review of 805 wrists. Can J Surg 2019; 62 (03) 1-12
• 19 Daly LT, Daly MC, Mohamadi A, Chen N. Chronic scapholunate interosseous ligament disruption: a systematic review and meta-analysis of surgical treatments. Hand (N Y) 2020; 15 (01) 27-34
• 20 Matheson LN, Isernhagen SJ, Hart DL. Relationships among lifting ability, grip force, and return to work. Phys Ther 2002; 82 (03) 249-256
• 21 Armijo-Olivo S, Woodhouse LJ, Steenstra IA, Gross DP. Predictive value of the DASH tool for predicting return to work of injured workers with musculoskeletal disorders of the upper extremity. Occup Environ Med 2016; 73 (12) 807-815
• 22 Fassler PR, Stern PJ, Kiefhaber TR. Asymptomatic SLAC wrist: does it exist?. J Hand Surg Am 1993; 18 (04) 682-686
• 23 De Smet L, Goeminne S, Degreef I. Failures of the three-ligament tenodesis for chronic static scapholunate dissociation are due to insufficient reduction. Acta Orthop Belg 2011; 77 (05) 595-597
• 24 Pauchard N, Dederichs A, Segret J, Barbary S, Dap F, Dautel G. The role of three-ligament tenodesis in the treatment of chronic scapholunate instability. J Hand Surg Eur Vol 2013; 38 (07) 758-766
• 25 Goeminne S, Borgers A, van Beek N, De Smet L, Degreef I. Long-term follow-up of the three-ligament tenodesis for scapholunate ligament lesions: 9-year results. Hand Surg Rehabil 2021; 40 (04) 448-452
• 26 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 (09) 1469-1477
• 27 Nienstedt F. Treatment of static scapholunate instability with modified Brunelli tenodesis: results over 10 years. J Hand Surg Am 2013; 38 (05) 887-892
• 28 Sousa M, Aido R, Freitas D, Trigueiros M, Lemos R, Silva C. Scapholunate ligament reconstruction using a flexor carpi radialis tendon graft. J Hand Surg Am 2014; 39 (08) 1512-1516