gms | German Medical Science

Objectives/Interrogation: Aim of this study was to evaluate the long-term effectiveness of the DRAW technique, which is a personal arthroscopic-assisted minimally invasive technique to reconstruct the scapholunate (SL) ligament using the trapezoid-to-second metacarpal joint bone-ligament-bone graft.

Methods: Between January 2009 and June 2014, thirty-one patients underwent the arthroscopic-assisted minimally invasive technique to reconstruct the SL ligament. All patients presented with chronic (>6 weeks) SL dissociation (19 Geissler type III, 12 Geissler type IV lesions) and no signs of arthrosic degeneration. Briefly, the surgical technique consisted in: SL rotatory subluxation reduction and stabilization with percutaneous K-wires, trapezoid-to-second metacarpal graft harvesting that was eventually advanced and secured within a tunnel created through the SL bones. A volar cast in neutral position of the wrist was applied and maintained in place for about 2 months when K-wires were removed and active range of motion exercises began. Follow-up visits were performed at 3, 6, 12 months, and every year afterwards. Radiographic, functional, and subjective outcome measurements were collected during the outpatient visits. Statistical analysis was performed with a significance threshold of P < 0.05.

Results and Conclusions: Mean follow-up was 71.55 months (range 50 to 115). All the grafts were in place with no SL synostosis or any carpal bone necrosis reported. No progression toward SLAC was observed in any patient. Only four patients had SL gap > 3 mm at the final follow-up however they returned to a pain-free wrist that allowed returning to their daily life activities. Patients were returned to work by the end of the 4th month and to contact sports and heavy jobs by the end of the 6th month. All the radiographic, functional and subjective outcomes analyzed not only significantly improved between the preoperative period and the 24-month follow-up but they also were maintained at the last follow-up or further improved (wrist mobility, grip strength). The DRAW technique ensures anatomical SL ligament reconstruction through a minimally invasive arthroscopic-assisted technique that does not require extensive capsulotomy, hence dramatically lowering the risk for reduced postoperative wrist mobility. The restored normal kinematics was also demonstrated by the long-term follow-up, where functional outcomes were even improved, while wrist degenerative changes were prevented.