Article
Arthroscopic-assisted capsuloplasty in scapholunate tears: The role of the dorsal capsulo-scapholunate septum
Search Medline for
Authors
-
Adrian Pleßmann
- Orthopädische Klinik Markgröningen, Markgröningen, Germany
-
Max Haerle
- Orthopädische Klinik Markgröningen, Markgröningen, Germany
-
Nicole Schmelzer-Schmied
- Orthopädie Rosenberg AG, St. Gallen, Switzerland
-
Tobias Del Gaudio
- Kliniken Villingen-Schwenningen, Villingen-Schwenningen, Germany
| Published: | February 6, 2020 |
|---|
Outline
Text
Objectives/Interrogation: Carpal instabilities and in particular the complex consequences of scalpholunate (SL-) dissociation are still subject to investigation. Recent biomechanical findings (Elsaidi et al., 2004) suggest that a new found anatomical structure - the Dorsal Capsulo-Scapholunate Septum (DCSS) - stabilizes the scapholunate complex and thus makes an important contribution to this already complex biomechanical system (Overstraeten et al., 2013).
In the past, suture of the SL-ligament with an open approach showed mediocre results as well as soft tissue procedures, which were insufficient due to a SL-ligament avulsion. To address the Dorsal Capsuolo-Scapholunate Septum and to avoid soft-tissue problems we refined the arthroscopic technique: by using diverging needles instead of converging needles, we attempt to suture the remaining attachments of the Dorsal Capsulo-Scapholunate Septum.
Methods: Our prospective follow-up study was carried out as a bicenter study. Patients were stratified into groups of acute and chronic SL-lesions, dynamic or static SL instabilities and according to Messina-EWAS classification. Between 2009 and 2015 we performed 63 arthroscopically assisted dorsal SL-capsuloplasties. The clinical follow-up included an assessment to pain level, range of motion (ROM) and grip-strength. The radiographic follow-up was performed in terms of SL gap and SL angle.
Results and Conclusions: The radiographic 3,5-year mean follow-up showed a significant decreased SL-gap in the group of dynamic instabilities regardless of whether they were acute or chronic. Even for Messina-EWAS IIIB and IIIC stages we could show a significant decreased SL-gap. We found no significant impairment for range of motion. VAS at rest declined by 90%, under load by 70%. Regarding the Mayo Wrist Score the result were good with an average score of 83 points. Regarding the DASH score we achieved a mean of 12.7 points.
Our modified arthroscopic assisted SL-capsuloplasty is an effective and due to its nature as an minimal invasive approach less traumatic technique to stabilize the scapholunate complex. The results were better in dynamic than in static SL-lesions regardless if they have a acute or chronic entity. The DCSS seems to heal regardless of the lesions age but longer follow-up is necessary.
