gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Results of dorsal and volar reconstruction of scapholunate ligament with FCR tendon

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  • presenting/speaker Christian Kindler - Schoen Klinik Muenchen-Harlaching, München, Germany
  • Bernhard Lukas - Schoen Klinik Muenchen-Harlaching, München, Germany

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-693

doi: 10.3205/19ifssh1039, urn:nbn:de:0183-19ifssh10398

Published: February 6, 2020

© 2020 Kindler et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: The technique for scapholunate ligament (SLL) reconstruction described by Corella yields reliable and satisfactory results in patients with static or dynamic scapholunate dissociation.

Methods: Seven patients underwent dorsal and palmar reconstruction of the SLL with part of the FCR tendon using the Corella technique. We modified the original technique by reducing the arthroscopic to a mini-arthrotomy technique in order to minimize surgery time. The main goal was to avoid injury to the carpal extrinsic ligaments and the posterior interosseus nerve.

So far we report on our first 7 patients with a minimum follow up of 8 months, at least 3 more patients will follow until time of presentation. Clinical and radiological outcomes wer measured pre- and postoperative in a prospective manner.

Results and Conclusions: Patients were between 24 and 68 years of age at surgery; all were male. The operative hand was dominant in 57%. There was an average 5,5 months from the time of injury to surgery (range, 2 - 30 mo). A total of 86% had a static deformity.

Results of the Quick DASH showed an average of 7,7 (SD 4,7) postoperative. Grip strength (Jamar dynamometer) showed postoperative 42,0 kp (SD 9,9 kp) at the operated side versus 53,6 kp (SD 10,9) at non-operated side. Pain in rest (0-100, visual analog scale) improved from 0,8 (SD 1,2) preoperative to 0,7 (SD 1,5) postoperative, Pain in activity improved from 6,8 (SD 1,8) to 2,8 (SD 2,5).

Flexion-extension total arc of movement reduced from 109 degrees to 107 degrees (SD 12,0).

On x-ray, the SL interval improved from 5,6 mm (SD 1,5 mm) to 5,0 mm (SD 2,0 mm). The SL angle improved from 74 degrees (SD 5.7) to 70 (SD 8,6).

6 out of 7 patients would do the surgery again, 5 resulted in pain reduction, 6 were satisfied with the result, all 7 got back in their original occupation.

In our cohort this technique results in a satisfactory pain relief. The other clinical parameters were not statistically significant. On x-ray only in 3 of 7 patients we could improve the SL intervall (reduction of > 1mm) or the SL angle (reduction > 5 °) although all had obvious reduced SL intervall and angle intraoperative. In more than 50% the tendon reconstruction seems to fail over time. Possibly and we think most likely the FCR tendon does not heal within the carpal trabecular bone but at the cortical bone which is exposed only limited by this technique.