gms | German Medical Science

Objectives/Interrogation: Scapholunate advanced collapse (SLAC) of the wrist is one of the most common pattern of degenerative arthritis in the wrist. The hallmark of SLAC is scaphoid or scapholunate ligament injury with collapse on the radial side of the wrist. Surgical intervention is warranted for individuals with symptomcatic SLAC and degenerative disease that affects the radioscaphoid joint with sparing of the midcarpal joint and the radio-lunar joint. There are currently two main options for motion-preserving reconstruction and treatment for this disease. These include four-corner arthrodesis (4CA) and proximal row carpectomy (PRC). There is a lack of consensus in the literature regarding which of the two procedures provides an overall better result and better clinical outcomes. We conducted a systematic literature review and meta-analysis to identify any differences in the clinical outcomes 4CA to PRC for scapholunate advanced collapse. Our Hypothesis is that proximal row carpectomy will have increased range of motion, increased grip strength, and decreased level of pain when compared to four-corner arthrodesis

Methods: An electronic literature search of PubMed, Embase, OVID, and the Cochrane Library was conducted to identify studies published before January 2018. All randomized controlled trials and cohort studies evaluating clinical outcomes of four-corner arthrodesis versus proximal row carpectomy for the treatment of scapholunate advanced collapse were included. Primary outcome measures included flexion/extension range of motion, grip strength, and level of pain. Data were analyzed using Comprehensive Meta-Analysis (CMA) statistical software.

Results and Conclusions: Eight studies encompassing 355 patients met the inclusion criteria for the meta-analysis. Our meta-analysis indicated that when compared with 4CA, patients that underwent proximal row carpectomy had significantly increased flexion/extension range of motion by 14.2 degrees (p=0.008), significantly increased Grip strength by 7.2% (p=0.002), and reduced level of pain by 0.69 (p=0.011).

This study demonstrated that PRC is superior to 4CA for the treatment of scapholunate advanced collapse. Compared with 4CA, patients treated with PRC had increased range of motion, increased grip strength, and decreased pain. Limitation to these findings is the small number of studies available and the increased heterogeneity between the studies. Further studies need to be conducted to confirm these findings.