gms | German Medical Science

Objectives/Interrogation: Small ligament - great impact; that could be the description of the scapholunar ligament. Damage to the SL ligament can lead to instability and cause scapholunate advanced collapse or SLAC wrist. Over the years various ligament reconstruction or tenodesis techniques have been described. However, as of today, there is no internationally recognised "gold standard". The long-term clinical results are usually limited and some techniques result in disproportionate collateral damage.

Methods: Recently, we use the fibertape (Fa. Arthrex), which is among others used in the arthroscopic rotator cuff repair, in combination with two anchors for fixation. In this technique, small incisions are made over the dorsal capsule for the introduction of the anchors, while preserving the ligamentous structures. With the development of new anchors the tape can be installed with a pretension after the reduction. Up to now we refused on the transfixation pinning of the carpus, because of the clinical and radiological stability during mobililsation. Additional morbidity from e.g. harvesting tendons may be dropped. After the surgery the patients are immobilised in a splint for 6 weeks, and full stressing is possible after 12 weeks.

Results and Conclusions: So far, nine patients with the appropriate indication were supplied with these surgical technique. The longest follow up period is 5 years. Active wrist range of motion, grip strength and radiological appearance are promising.

After cadaver training, we are using this new method on suitable patients. The first experience has been encouraging. Larger numbers of cases and long- term results will show, if these method can become established. A positiv effect is the less effort, the gentle preparation while preserving ligaments, waiving of transfixation and shorter immobilization.