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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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Short to mid-term results of a 360 degree technique for reconstruction of the scapho-lunate ligament

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  • presenting/speaker Allan Ibsen Sorensen - Sahlgrenska University Hospital, Gothenburg, Sweden

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. DocIFSSH19-476

doi: 10.3205/19ifssh1042, urn:nbn:de:0183-19ifssh10423

Published: February 6, 2020

© 2020 Ibsen Sorensen.
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 aim of this prospective study is to present short to mid-term results of a 360 degree technique for reconstruction of the scapholunate (SL) ligament.

Methods: Patients with a symptomatic SL ligament lesion Geisler type 3 or 4 were included. In the technique for reconstruction a part of Flexor Carpi Radialis or Plantaris tendon was used to stabilize on both the dorsal and volar side of the scapholunate joint. Temporary K-wire fixation was not used in the later part of the study. All the patients had a cast for 6 weeks.

All patients were evaluated preoperatively, 12 and 26 weeks postoperatively and then yearly with ROM, grip strength, VAS scores for pain and satisfaction, Quick-DASH and PRWE-questionnaires. X-Ray was performed preoperatively, 3 months postoperatively and thereafter yearly.

Forty-seven patients were operated and 2 patients twice, 39 men and 8 woman. Median age 42 years (19-61). Mean values are used.

Results and Conclusions: Median follow-up was 31 months (range 3-89). 6 patients had Geisler 3 and 41 Geisler 4 status preoperatively.Early changes of the cartilage of the proximal pole of the scaphoid was found preoperatively in 20 (43%) patients. Preop. SL distance on x-ray was 5.4mm (1.4-8.3) and at last follow-up (LFU) 3.5 mm (0-9.4) (P<.01). Dorsal/volar flexion was preop. 89% (range 17-185%) of the contralateral wrist and at LFU 72% (31-114) (P<0.01). Radial/ulnar deviation was 85% (23-193%) versus 89% (22-191%) postoperatively (P=NS). Grip strength preop. was 36 KgF (2 -60) and at (LFU) 35 (4-67) (P=NS). VAS for pain (mm) was preop. at rest/activity; 28/56 and at LFU; 23/36 (P=NS/<.01). Watsons test was positive in of 39 of 42 cases preop and positive in 13 of 49 at LFU (P<0.01). Radiographic dorsal intercalated segment instability (DISI) was seen in 22 of 47 cases preop. compared with 26 of 47 at last Follow-up. Quick DASH and PRWE preop: 41 and 52 and at LFU; 30 and 35 (P<0.01). Patients VAS of Satisfaction improved from 26 (0-100) Preop. to 62 (0-100) at LFU(P<0.01).

Six developed SLAC wrist. Five revisions (10.2 percent) were performed, two with a new ligament with the same technique, one to an arthrodesis of the wrist and one to a proximal row carpectomy and one scheduled to four corner arthrodesis.

This 360 degree technique for reconstruction of the SL ligament improved Quick-DASH, PRWE, VAS for pain in activity and patients satisfaction. Revision rate is so fare acceptable low, but longer follow-up is needed to evaluate this technique.