Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability

The Journal of Hand Surgery
Nickolaos A DarlisDean G Sotereanos

Abstract

For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure. Eleven patients (mean age, 37 y) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with dynamic SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a Geissler grade III or IV SL tear) and treated. Range of motion, grip strength, radiographic measurements, and the Mayo wrist score were used to evaluate the results. The mean follow-up period was 33 months (range, 12-76 mo). Three patients had subsequent surgery 9 to 11 months after the procedure. Subsequent surgeries included a dorsal capsulodesis, a four-corner fusion, and a wrist arthrodesis. Of the 8 remaining patients there were 2 excellent, 4 good, 1 fair, and 1 poor result based o...Continue Reading

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Citations

Jun 25, 2013·Archives of Orthopaedic and Trauma Surgery·Gertraud GradlKarl-Josef Prommersberger
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Jan 22, 2019·The Journal of Hand Surgery, European Volume·Jin-Kak KimGab-Lae Kim
May 4, 2021·The Bone & Joint Journal·Sanjeev KakarJohn R Fowler

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