Arthroscopic scapholunate joint reduction. Is an effective treatment for irreparable scapholunate ligament tears?

BACKGROUND: Irreparable tears to the scapholunate (SL) interosseous ligament area are common causes of mechanical wrist pain and yet treatment of this condition remains challenging. The reduction association of the SL joint (RASL) technique alleviates pain while preserving wrist function by creating a fibrous pseudarthrosis stabilized by a cannulated screw placed through the SL joint. Although arthroscopic RASL (ARASL) is a minimally invasive alternative to the open procedure, its effectiveness in controlling pain and preserving wrist function has not been established.

QUESTIONS/PURPOSES: To determinate whether ARASL was obtained relieve pain and restore function to the wrist.

PATIENTS AND METHODS: We reviewed eight patients (nine wrists) who had ARASL for SL instability with a reducible SL ligament tear (chronic lesion) from 2005 to 2009. Seven of eight were males and mean age was 44.5 years (range, 38-56 years). We recorded pain using a scale, the Disabilities of the Arm, Shoulder and Hand (DASH) score, grip strength, and range of motion (ROM). Minimum followup was 12 months (mean, 34.6 months; range, 12-43 months).

RESULTS: The visual analog pain score was rated 5.4 (range, 0-10) preoperatively and 1.5 (1-3) after ARASL. Postoperative grip strength of the wrist was 78% of the contralateral, unaffected wrist. The average postoperative wrist ROM was to 107°, 20% less than the preoperative ROM. The SL angle decreased from 70.5° to 59.3°. In three cases, screws were removed owing to loosening or symptoms.

CONCLUSIONS: Our preliminary observations suggest ARASL for treating irreparable SL ligament tear is feasible, controls pain, and improves wrist function while preserving ROM. Larger series with longer followup are required to confirm our observations.

LEVEL OF EVIDENCE: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.