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Injury to the scapholunate complex is the cause of scapholunate instability which can lead to radiocarpal and medio-carpal osteoarthritis. Several ligamentoplasty techniques have been reported for the treatment of chronic scapholunate instability before the osteoarthritis stage. The objective of this study was to assess the short-term results of an "all dorsal scapholunate repair" ligamentoplasty. We report the clinical, radiological and functional results of a retrospective study including 21 patients, operated between June 2019 and December 2020 for a stage 3 or 4 scapholunate instability according to the Garcia Elias classification. With a follow-up of 14.2 months, the pain was 0.1/10 according to the VAS at rest and 4/10 during exercise. Wrist strength was measured at 65% of the opposite side. The flexion–extension range of motion was 105°. Radiologically, there was a reduction of the diastasis and scapholunate angle. Osteolysis areas around the anchors were described in 47% of patients. The mean QuickDASH was 29.2/100, PRWE 24/100 and Mayo wrist score 67.8/100. Eighty-one percent of patients were satisfied. Seventeen patients had returned to work 5.2 months postoperatively. In the case of work-related injury, the functional scores were poorer, with a delayed return to work. This technique provides encouraging results in the short term. Most patients were improved compared to preoperative state. The work-related injury appears to be a poor prognostic factor. A longer-term study is imperative to confirm the maintenance over time of the correction of carpal malalignment and the evolution of the osteolysis areas. Level of evidence: Level IV Retrospective study. [ABSTRACT FROM AUTHOR]

An instructional review of the anatomy, investigation, and management of scapholunate ligament injuries. Aimed at the knowledge level required for the trauma and orthopaedic FRCS examination. [ABSTRACT FROM AUTHOR]

Scapholunate instability (SLI) is the most common carpal instability described. SLI leads to a degenerative arthritic pattern known as scapholunate advanced collapse (SLAC). Diagnosis of SLI can be challenging in pre-dynamic and dynamic stages. CT arthrogram, MR arthrogram and dynamic fluoroscopy are helpful in diagnosis while arthroscopy remains the gold standard. SLI is a multi-ligament injury, which involves not only the scapholunate interosseous ligament (SLIL) but also the extrinsic carpal ligaments. Hence, it is better described as an injury compromising the 'dorsal scapholunate(dSLL) complex'. A repair can be attempted for acute SLI presenting within 6 weeks of injury. Reconstruction is the mainstay of treatment for chronic SLI without degenerative changes. Multiple repair techniques have been described which include capsulodesis and tenodesis procedures. The clinical outcomes of the techniques have improved over the years. However, a common problem of all these techniques is the lack of long-term data on the outcomes and deteriorating radiological parameters over time. SLI staging is an important factor to be considered in choosing the reconstruction techniques for a better outcome. Currently, there is a trend towards more biological and less invasive techniques. Regardless of the technique, it is important to preserve the nerve supply of the dorsal capsuloligamentous structures of the wrist. Arthroscopic techniques being minimally invasive have the advantage of less collateral damage to the capsuloligamentous structures. Rehabilitation involves a team approach where a protected dart thrower's motion is allowed after a period of immobilization. Strengthening SL-friendly muscles and inhibiting SL-unfriendly muscles is a key principle in rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Although it is part of the common clinical examination of scapholunate ligament pathologies, there are only little data on the diagnostic value of the scaphoid shift test. The aim of this study was to evaluate the scaphoid shift test in a large cohort of patients. Materials and Methods: We retrospectively analysed 447 patients who underwent the scaphoid shift test and wrist arthroscopy because of various suspected injuries of the wrist, correlating the results of clinical examination with data obtained during the wrist arthroscopy. Sensitivity, specificity, and positive and negative predictive values were calculated and evaluated. Results: The sensitivity of the scaphoid shift test was low (0.50) when examining the whole cohort. In a subgroup of patients specifically referred for suspected scapholunate ligament injury, the sensitivity was higher (0.61), but the specificity was low (0.62). In detecting more serious lesions (Geissler 3 + 4), the scaphoid shift test demonstrated higher sensitivity (0.66). Conclusions: An isolated scaphoid shift test may only be of limited value in the diagnosis of scapholunate ligament lesions and should, therefore, be viewed as a useful tool for a preliminary assessment, but a negative test should not prevent the surgeon from indicating a more extensive diagnostic workup. [ABSTRACT FROM AUTHOR]

PURPOSE OF THE STUDY: Fractures of the distal radius are frequently associated with injuries of the scapholunate (SL) and lunotriquetral (LT) ligaments. Our study is aimed at revealing their hidden lesions by employing a fast and accessible fluoroscopic identification. PATIENTS AND METHODS: We investigated 40 patients who were indicated for plate osteosynthesis of distal radius fracture. After completing the osteosynthesis, the procedure was concluded with a wrist arthrography. The patients with SL and LT interval lesions had their wrists immobilized by a plaster splint while patients with normal findings with an elastic bandage. The patients were followed up for 12 months after the surgery. The functional results were evaluated by Mayo wrist score. RESULTS: The intra-operative examination identified 62.5 % of patients with lesions of SL and/or LT interval, and 37.5 % of patients were lesion-free. The Mayo wrist scores after 3, 6 and 12 months in patients whose wrists were not immobilized were 72, 86.3, and 86.3, respectively. The latter scores in the group of patients with external immobilization were 54.4, 82, and 84.8, respectively. The difference between the groups was significant three months after the surgery. After six and twelve months, the difference became negligible. CONCLUSION: The exclusion of hidden lesions allows earlier rehabilitation, while in patients with signs of lesions, it is appropriate to immobilize the wrist (Tab. 1, Fig. 3, Ref. 31). Text in PDF www.elis.sk [ABSTRACT FROM AUTHOR]

Objective: To demonstrate the utility of MRI in separating clinically relevant from minor or incidental lesions of the triangular fibrocartilage complex and the major interosseous ligaments in the wrist. Materials and methods: In this retrospective study, we identified 89 patients and correlated MRI finding with subsequent arthroscopy. Triangular fibrocartilage complex abnormalities have been subdivided into disc lesions—central and radial—or ulnar-sided tears according to MRI appearances and surgical findings as the clinical and surgical approach is very different. Interosseous ligament tears were subdivided into partial or complete, highlighting the principle of recognising surgically relevant lesions. Results: For simple central to radial tears and perforations of the triangular fibrocartilage complex, MRI was 98.3% accurate. MRI identified all peripheral triangular fibrocartilage complex tears seen at arthroscopy; however, the specificity of 66.7% may reflect partly the use of arthroscopy limited to the radiocarpal joint. MRI proved 95.4% accurate for surgically relevant scapholunate interosseous ligament tears and was highly accurate at separating limited from complete lunotriquetral interosseous ligament tears showing 100% accuracy for complete tears. Conclusions: The study shows excellent correlation between MRI and arthroscopic findings that determine surgical relevance with a very high sensitivity for triangular fibrocartilage complex lesions and accurate separation of minor versus surgically relevant ligamentous tears. [ABSTRACT FROM AUTHOR]

Aim: The aims of the study were to perform an ultrasound assessment of the dorsal portion of the scapholunate interosseous ligament and scapholunate joint space in patients with wrist complaints in a rheumatologic setting, to describe ultrasound abnormalities about scapholunate interosseous ligament region, and to correlate them with clinical data, presence of dorsal ganglion cysts and diagnoses of rheumatic diseases. Material and methods: Seventy-four consecutive patients with wrist pain and/or swelling were evaluated by routine power Doppler ultrasound. Forty normal wrists were studied to confirm the normality values of the scapholunate joint. Results: The mean width of the normal scapholunate joint was 2.49 mm (±0.49 SD), with a coefficient of variation on repeated measurements of 3.662%. The best predictors of scapholunate interosseous ligament degeneration were: older age (p <0.0001), male gender (p = 0.0049), and radiocarpal effusion (p = 0.0156). The presence of osteophytosis and calcifications of the scapholunate joint were higher (p <0.001) in rheumatic patients. Scapholunate calcifications showed a sensitivity of 98.2% and a specificity of 61.1% for calcium pyrophosphate deposition disease. Dorsal ganglion cysts were more frequent in younger subjects (p <0.0012) without rheumatic conditions (p <0.0001) or midcarpal synovitis (p <0.0001). Larger cysts often exhibited power Doppler signal (p <0.0001). The best predictors of scapholunate dissociation were: male gender (p = 0.0002), presence of midcarpal synovitis (p <0.0137), and higher grade of scapholunate interosseous ligament degeneration (p <0.0001). Scapholunate widening was greater (p = 0.0419) in calcium pyrophosphate deposition disease or rheumatoid arthritis than in other rheumatic conditions. Conclusions: Ultrasound findings of scapholunate interosseous ligament degeneration and calcification, scapholunate space enlargement, and dorsal ganglion cysts should be considered in ultrasound reporting, since they add useful information about the diagnosis of associated rheumatic conditions. [ABSTRACT FROM AUTHOR]

Background: Early detection of scapholunate ligament (SLL) tears is essential after minor and major trauma to the wrist. The differentiation between stable and instable injuries determines therapeutic measures which aim to prevent osteoarthritis. Arthroscopy has since been the diagnostic gold standard in suspected SLL tears because non-invasive methods have failed to exclude instable injuries reliably. This prospective study aims to determine the diagnostic accuracy of dynamic, 4D computed tomography (CT) of the wrist for diagnosing instable SLL tears.Methods: Single center, prospective trial including 40 patients with suspected SLL tears scheduled for arthroscopy. Diagnostic accuracy of 4D CT will be tested against the reference standard arthroscopy. Radiologists will be blinded to the results of arthroscopy and hand surgeons to radiological reports. A historical cohort of 80 patients which was diagnosed using cineradiography before implementation of 4D CT at the study site will serve as a comparative group.Discussion: Static imaging lacks the ability to detect instable SLL tears after wrist trauma. Dynamic methods such as cineradiography and dynamic magnetic resonance imaging (MRI) are complex and require specific technical infrastructure in specialized centers. Modern super-fast dual source CT scanners are gaining popularity and are being installed gradually in hospitals and ambulances. These scanners enable dynamic imaging in a quick and simple manner. Establishment of dynamic 4D CT of the wrist in patients with suspected SLL tears in in- and outpatient settings could improve early detection rates. Reliable identification of instable injuries through 4D CT scans might reduce the number of unnecessary diagnostic arthroscopies in the future.Trial Registration: This study was registered prospectively at the German Clinical Trials Register (DRKS) DRKS00021110 . Universal Trial Number (WHO-UTN): U1111-1249-7884. [ABSTRACT FROM AUTHOR]

Scapholunate ligament (SLL) injury represents a hazard to the wrist and the treatment of these injuries has been the focus of much debate. We performed a long-term follow (>10 years) of triscaphoid arthrodesis for symptomatic chronic SLL injuries in 10 (8 men) patients 37 (22–49) years of age. All arthrodesis healed. One patient was converted to total wrist arthrodesis during the follow-up period, and three had minor additional surgeries. At final follow-up, the patients had reduced active range of motion (AROM, 55%) and grip strength (85%) compared to the opposite side, but reported low Quick Disability of Arm, Shoulder and Hand (QDASH) (11), Patient-Rated Wrist and Hand Evaluation (PRWHE) (25) and visual analog scale (VAS) pain scores (0 and 10 at rest and activity). Radiographs found minimal degenerative changes in four patients, while CT scans demonstrated changes in seven patients, in three of these scaphoid was subluxed on the rim of the radius. The patients working prior to surgery were working at follow-up. A triscaphoid arthrodesis for SLL renders a functional wrist function in most patients for many years and has postponed more extensive surgery like total wrist arthrodesis or wrist arthroplasty. The patients are still young, and the degenerative changes seen especially on CT scans warrants attention. [ABSTRACT FROM AUTHOR]

Ultrasonography is a commonly utilized tool in orthopedic surgery for the diagnosis and treatment of a variety of musculoskeletal conditions, including pathology about the wrist. Its value should not be underestimated when other diagnostic resources are unavailable - such as in a combat setting where ultrasounds, but not X-ray, are a standard equipment item. An active duty soldier presented to an orthopedic provider in an austere environment with chronic dorsal wrist pain due to a previous fall. Physical examination and dynamic ultrasound examination allowed the deployed provider to diagnose a scapholunate ligament injury. The patient was appropriately evacuated to a higher level of care without the need for X-ray or other advanced imaging modalities. Making this readily available resource a standard tool for providers deployed to a forward location could be beneficial for efficient and appropriate patient evacuation for musculoskeletal injuries. It can also rule out injuries that would otherwise have required unnecessary soldier movement through hostile territory for diagnostic tests such as X-rays. In addition, a simple technique and pearls for ultrasonography of the wrist are provided. [ABSTRACT FROM AUTHOR]

• Accurate 3D tracking of wrist kinematics using biplanar X-rays. • New protocol to investigate wrist kinematics and effects of surgical repair. • Scapholunate ligament lesion induced an increase in scaphoid flexion. • The additional volar repair improved scaphoid kinematics. • The additional volar repair reduced the gap between scaphoid and lunate. The scapholunate joint is one of the keystones of the wrist kinematics, and its study is difficult due to the carpal bones size and the richness of surrounding ligaments. We propose a new method of quantitative assessment of scapholunate kinematics through bone motion tracking in order to investigate scapholunate ligament lesion as well as repair techniques. On 6 intact wrists, steel beads were inserted into the bones of interest to track their motions. Experimental set up allowed wrist flexion extension and radio-ulnar deviation motions. Low-dose bi-planar radiographs were performed each 10° of movement for different configurations: 1) intact wrist, 2) scapholunate ligament division, 3) repair by soft anchors at the posterior then 4) anterior part. Beads' 3D coordinates were computed at each position from biplanar X-Rays, allowing accurate registration of each wrist bone. The Monte Carlo sensitivity study showed accuracy between 0.2° and 1.6 ° for the scaphoid and the lunate in motions studied. The maximum flexion-extension range of motion of the scaphoid significantly decreased after anterior repair from 73° in injured wrist to 62.7°. The proposed protocol appears robust, and the tracking allowed to quantify the anchor's influence on the wrist kinematics. [ABSTRACT FROM AUTHOR]

Scaphoid and lunate mobility has been suggested to be minimal during the dart-throwing motion in studies based on serial computed tomography (CT) scans and cadaver studies. This study analyzes the direct motion between the scaphoid and the lunate during the dart-throwing motion in vivo. We examined nine individuals with standard CT scans of the wrist in radial extension and ulnar flexion. The paired CT scans were analyzed with a volume registration technique. The lunate was registered as fixed and the scaphoid as the mobile element. The motion of the scaphoid relative the lunate between the positions of radial extension and ulnar flexion was measured. There was considerable motion between the scaphoid and the lunate with both a distal to proximal translation and rotation during the dart-throwing motion, regardless of whether the scapholunate ligament was intact or not. These results suggest that aggressive dart-throwing exercises should not be implemented early on during rehabilitation following scapholunate repair. [ABSTRACT FROM AUTHOR]

Background: The purpose of our study was to compare magnetic resonance arthrography (MRA) as a diagnostic modality against the gold standard of wrist arthroscopy in the evaluation of chronic wrist pain. Materials and Methods: Thirty three patients with chronic wrist pain suspected to have ligament injuries of the wrist were prospectively recruited. They underwent MRA examinations followed by wrist arthroscopy. Arthroscopic findings were compared with radiological findings focusing on three important structures – triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL). Results: For the 17 patients with TFCC tears/perforations on arthroscopy, MRA gave a sensitivity (SEN) = 88%, specificity (SPE) = 87.5%, positive predictive value (PPV) = 88%, and negative predictive value (NPV) = 87.5%. For the 13 patients with SLL tears on arthroscopy, MRA gave SEN = 77%, SPE = 100%, PPV = 100%, and NPV = 87%. For the 7 patients with LTL tears on arthroscopy, MRA gave SEN = 29%, SPE = 100%, PPV = 100%, and NPV = 84%. A composite correlation between findings on MRA and wrist arthroscopy revealed an overall SEN = 73%, SPE = 96%, PPV = 93%, and NPV = 85% for MRA, with overall accuracy = 88%. Conclusions: The presented diagnostic results of MRA are superior to those of magnetic resonance imaging quoted in literature. MRA is a potent tool for evaluating chronic wrist pain but tends to miss lesions of intrinsic carpal ligaments (SLL and LTL) more than TFCC. Wrist arthroscopy may be recommended when the clinical suspicion is strong. [ABSTRACT FROM AUTHOR]

Background: In post-traumatic, dynamic, or static scapholunate (SL) instability, an SL ligament reconstruction is advisable to avoid long-term complications. However, a sufficient primary reconstruction is best achieved in acute injuries. For chronic SL dissociation, there is still no satisfying standard surgical technique. In this context, we evaluated the clinical outcome of Weiss's osteoligamentoplasty as a treatment option. Methods: Over a three-year period, 16 patients with chronic and symptomatic SL dissociation Grade-II and III, without the signs of osteoarthrosis were, surgically treated using a bone-retinaculum-bone autograft from the distal radius. All patients underwent prior wrist arthroscopy. The clinical outcome was measured using the Mayo-Wrist, Krimmer, and DASH score. In addition, radiological measurements were also performed. Results: The postoperative clinical outcome successfully increased the Mayo-Wrist score: 32 to 64 points, Krimmer score: 30 to 53 points and DASH score: 41 to 30 points. The radiological follow-up demonstrated no evidence of an SL gap or significant loss of reposition in the SL angle in 13 of the 16 cases. Till date, two patients had to be revised to an arthrodesis. Conclusions: The autogenous osteoligamentary span from the distal radius improves a chronic SL dissociation and, therefore, presents a suitable option to anatomically reconstruct the SL ligament. It leads to a proper realignment of the carpus and could help to prevent arthritic changes of the wrist. Nevertheless, in patients with postoperative high occupational physical strain, the procedure should be performed with reservations. As long as there is no satisfying standard surgical treatment, Weiss's osteoligamentoplasty is a convincing technique. [ABSTRACT FROM AUTHOR]

Scapholunate ligament (SLL) injuries are a common cause of wrist pain and instability. Treatment of SLL injuries requires intricate understanding of wrist anatomy and biomechanics. Mindful physical exam and appropriate diagnostic studies can orient the surgeon to the defined stage of injury. Review of the literature on each treatment by stage can prepare the upper extremity surgeon to provide the best evidence-based care. The optimal management of SLL injuries should result in a stable, painless wrist. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate different features of ganglion cyst by using ultrasound and its exact localization in relation to adjacent tendons, ligaments, arteries and joints. METHODOLOGY: A cross sectional study was conducted in Department of Radiology, Dallah Hospital, Riyadh. Study duration was 1 year (1st August 2016 to 31st July 2017). A sample size of 89 patients was achieved using simple random sampling (Lottery Method). Patients diagnosed with ganglion cysts based on USG findings using MRI as gold standard, both genders and age greater than 18 years were included. Superficial ultrasound with high frequency transducer was performed in all patients, probe frequency ranging from 12 to 18 MHz. Ethical approval was taken from ethical review board of Dallah Hospital and consent was taken from patients. Data was analyzed using SPSS Software version 20. Chi-square test was applied for observing association between different variables. RESULTS: Total 89 patients were included in study. There were 25 (28%) males and 64 (72%) females. Mean age of patients was 43.6 ± 14.8 SD. Most common location of ganglion cyst in relation to joint, ligament, tendon & artery was anterior to scapholunate ligament 9 (10.1%) and around scapholunate joint dorsal aspect of wrist 18 (20.1%), volar surface 10 (11.2%) and medial to radial artery 2 (1.1%) respectively. A significant association was reported between limb & anatomical side (p=0.03), margins & echogenicity (p=0.03). CONCLUSION: Ultrasound is the primary imaging modality for evaluation and localization of ganglion cysts. Majority of ganglion cysts appear anechoic, have smooth margins and demonstrate clear internal content with no septation or echoes. Moreover, ganglion cysts occur most commonly adjacent to scapholunate ligament on dorsal surface of wrist. Although diagnosis of ganglion cysts is rarely a problem, we believe ultrasound allows accurate evaluation of ganglion cysts even as small as 2 mm, which are difficult to appreciate clinically or on MR imaging. [ABSTRACT FROM AUTHOR]

The main problem in the diagnostics of scapho-lunate ligament injury is the relative rare detailed clinical and radiologic picture, the lack of information and pronounced dissonance between anatomic types if injuries and clinical symptoms. Methods: we examined 63 patients (47 men, 16 female, average age 34.4 years) who had surgery treatment because of scapho-lunate ligament injury. We assessed the informative (sensitivity/specificity) of clinical signs and data obtained with X-ray, computer tomography, magnetic resonance investigation and ultrasound. Results: in the basis of scapho-lunate ligament injury lies the progressive instability with extensor contracture and degenerative changes in radial joint. The diagnostics of the early stages of ligament injury is based on anamnesis morbid and quite sensitive clinical tests: Watson -- 96%, scapho-lunate displacement -- 53%, «flexed wrist-extension fingers» -- 75%. But because of their low specificity (4-6%) additional methods of examination are needed -- X-ray, computer tomography, magnetic resonance investigation, ultrasound. Conclusions: for those injuries which accompined with static instability we use X-ray or computer tomography in order to identify such signs as «Terry Thomas» symptom, «ring», scaphoid shortening. Their sensitivity at the IV-VI stages is almost 100%. In cases of I-III stages of ligament injury the most specificity is magnetic resonance investigation study. Ultrasound is high informative at ligament injury and carpal instability, but it does not give the full picture of disorganization of wrist joint, it does not give opportunity to divide the stage of injury and choose the method of treatment, so it can be as additional method of examination. [ABSTRACT FROM AUTHOR]

Objective:The total number and cost of wrist MRIs in the catchment area of the Västra Götaland Region in Sweden (population 1 723 000) during 1 year was analysed, together with the number and content of referrals. Methods:Six radiology departments reported the numbers and rate of all MRI investigations intended to diagnose wrist ligament injuries (n = 411) and other injuries to the wrist. Results:The additional cost of the difference between MRIs and a clinical examination by a hand surgeon, plus indirect costs for patients with suspected wrist ligament injuries, was calculated as 957 000 euros. Conclusions:It is recommended that MRI should only be used in patients in whom there are clinical difficulties in terms of diagnosing wrist ligament injuries. It is suggested that patients with suspected wrist ligament injuries should be referred directly to an experienced hand surgeon, capable of performing a standardised wrist examination and, when needed, diagnostic arthroscopy and final treatment. The proposed algorithm for the diagnosis and treatment of suspected wrist ligament injuries presented in the present study could save time for the patient and for the radiology departments, as well as reducing costs. The ability to implement the early and appropriate treatment of acute ligament injuries could be improved at the same time. [ABSTRACT FROM PUBLISHER]

Since its introduction in 1979, the practice of and indications for wrist arthroscopy in the diagnosis and treatment of pathologic conditions in the wrist continues to grow. Magnetic resonance imaging (MRI) is another commonly used tool to noninvasively examine the anatomy and pathology of the wrist joint. Here, we review the normal wrist anatomy as seen arthroscopically and through MRI. We then examine the various common pathologic entities and define both the arthroscopic findings and correlated MRI findings in each of these states. [ABSTRACT FROM AUTHOR]

Scapholunate dissociation (SLD) is a form of carpal instability, caused by rupture of the scapholunate ligament (SLL) the secondary stabiliser of the scapholunate (SL) compartment. SLD can cause osteoarthritis of the wrist. Recently a study was published that shows cineradiography to be an excellent radiological imaging technique for diagnosing SLD at a tertiary centre for hand and wrist surgery [1]. As the quality of these results can be influenced by the expertise of the operator and observer of the cineradiographic studies, the aim of this study was to determine if these results were reproducible at a secondary centre for hand and wrist surgery with less expertise in wrist cineradiography. All cineradiographic studies carried out during a 10-year period were obtained. All patients who underwent the gold standard procedure (arthroscopy/arthrotomy) after cineradiography were included, a total of 50 patients. The diagnostic accuracy of detecting SLD by both cineradiography and conventional radiography was calculated. Cineradiography had a high diagnostic accuracy, while the accuracy for conventional radiography was average. When all wrists with an SL distance ≥3mm were excluded (static SLD), diagnostic accuracy for conventional radiography dropped even lower, while accuracy for cineradiography remained high. These results are comparable with published accuracy rates and show that cineradiography has a high diagnostic value for detecting SLD and do not seem to be influenced by the operator or observer of the cineradiographic studies. [ABSTRACT FROM AUTHOR]

The aim of this work is to summarize the current options to imaging scapholunate ligament and its pathologies of methods readily available on almost all radiology departments through magnetic resonance imaging, including characteritics of eligible sequences. Authors demostrate pathology of the scapholunate ligament encountered in daily practice. [ABSTRACT FROM AUTHOR]

Purpose: To examine the relationship between video length for wrist arthroscopy and interobserver reliability.Materials and Methods: 100 consecutive wrist arthroscopies were documented by long and short videos of the radiocarpal and the midcarpal joints. The long videos were about twice as long as the short videos. They were presented randomly to two independent and blinded examiners. Their diagnoses were compared to the diagnoses made by the surgeon who performed the arthroscopies. Kappa coefficients were calculated.Results: Kappa statistics were inconsistent and did not show that the long video provided an obvious advantage over the short video. The Kappa coefficients of the two examiners for the assessment of the cartilage status were 0.524 and 0.700 for the long videos and 0.465 and 0.639 for the short videos, respectively. The examiners diagnosed twice as many false-positive cartilage lesions on short videos than on long videos. The assessment of ligament lesions was more accurate on long than on short videos.Conclusions: The results confirmed the hypothesis that the reproducibility of diagnoses based on video documents was influenced by the length of the video sequences. Therefore, it may be advisable for video documentation to be done diligently. The video sequence of the radiocarpal joint should last about 60 s, and that of a midcarpal joint should last about 45 s. Videos of difficult joints should last appropriately longer.Level Of Evidence: Diagnostic II. [ABSTRACT FROM AUTHOR]

Background: This retrospective study assessed the prevalence and outcome of intercarpal ligament injuries in non-osteoporotic patients with AO/ASIF classification type B distal radius shearing fractures treated with or without scapholunate temporary fixation. Methods: Fifteen patients (mean age, 33 years) were analyzed according to their scapholunate ligament status at the time of injury and graded with a modified Geissler classification system. Each patient's postoperative pain and occupational status were assessed in the context of the Modified Mayo wrist score. Second-look arthroscopy was performed for all cases. Results: Scapholunate ligament injuries were present in 14 of 15 type B fractures. Surgical outcomes yielded an improvement in the Mayo wrist score with pinning in cases involving grade 3 or 4 scapholunate injuries. Two cases without pinning had a worse score, as well as a persistent scapholunate tear that was not healed at second-look arthroscopy after eight postoperative months. However, in grade 1 or 2 scapholunate injuries, the Mayo wrist score did not differ between those treated with and without pinning. Conclusions: Scapholunate ligament injury is an important risk factor associated with high-energy distal radius shearing fractures. To prevent these problems, temporary scapholunate joint fixation is a recommended treatment for grade 3 or 4 scapholunate injuries. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to evaluate the influence of associated scapholunate (SL) and/or lunotriquetral ligament (LT) injury on the outcome of distal radius fractures. Materials and methods: This prospective study included 40 patients with surgically treated distal radius fracture. Wrist arthroscopy was used to identify associated lesions of the scapholunate and lunotriquetral ligaments and classify them according to Geissler. Patients were divided in two groups by presence (injured group) or absence (intact group) of associated injury of the SL and/or LT ligament. The patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) questionnaires were used to evaluate disability 3 and 6 months after injury. Grip strength was also evaluated. Results: Wrist arthroscopy identified SL and/or LT injury in 15 patients (37.5 %). Mean total PRWE score for the intact group was 26.64 at 3 months and 16.22 at 6 months, and 50.47 (at 3 months) and 20.7 (at 6 months) for the group with ligament injury. Mean DASH scores were 26.03 and 13 at 3 and 6 months for the intact group, and 49.5 and 24.11 for the injured group. Mann-Whitney test results showed significant difference for the PRWE and DASH scores and the grip strength for the two examined groups. Conclusions: Patients with distal radius fracture with associated intrinsic ligament injury had worse outcomes than did patients without associated ligamentous injury. Associated injuries of the SL and LT ligament should be considered when treating distal radius fractures, and wrist arthroscopy should be incorporated into the operative protocol. [ABSTRACT FROM AUTHOR]

Background: Acute rupture of the scapholunate interosseus ligament is a relatively frequent occurrence which can be repaired primarily by direct suturing. However, patients are often seen a few weeks after injury when most of the ligament fibers have degenerated. This poses a challenge because direct repair can be difficult and long term results have not been satisfying. In the present study, a technique is presented to address this problem and its possible advantages are discussed. Materials and Methods: A fresh frozen wrist cadaver specimen, thawed to room temperature, was used to carry out the procedure. The scapholunate joint was exposed through a dorsal approach and stabilized using two percutaneous Kirschner wires. Using a U shaped chisel, a groove along the scapholunate articular margin was created to accommodate a strip from the extensor retinaculum as a ligament plasty. This has been secured using six anchor sutures and several pictures taken during the procedure to expose the key steps. Results: The ligamentoplasty presented in this article preserves most of the articular surface of proximal carpus and at the same time stabilizes the scapholunate joint. However, more in vivo research should be carried out to validate this treatment. Conclusion: The technique suggests a possible way to repair a ruptured scapholunate interosseus ligament that cannot be repaired primarily. Because osteointegration of the ligament strips is not possible in the present experiment, biomechanics of the construct cannot be fully tested. [ABSTRACT FROM AUTHOR]

Aims: To compare conventional magnetic resonance imaging (MRI) and direct magnetic resonance (MR) arthrography in the evaluation of triangular fibrocartilage complex (TFCC) and intrinsic wrist ligament tears. Materials and Methods: T1‑weighted, fat suppressed (FS) proton density plus T2‑weighted (FS PD/T2), 3D multiple‑echo data image combination (MEDIC) sequences and direct MR arthrography were performed in 53 patients with wrist pain. Images were evaluated for the presence and location of TFCC, scapholunate ligament (SLL) and lunatotriquetral ligament (LTL) tears, and imaging findings were compared with operative findings in 16 patients who underwent arthroscopy or open surgery (gold standard). Results: Sixteen patients underwent arthroscopy/open surgery: 12 TFCC tears were detected arthroscopically out of which 9 were detected on FS PD/T2 sequence, 10 on MEDIC sequence, and all 12 were detected on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in the detection of TFCC tears were 75%, 83.3%, and 100%, respectively. Out of the eight arthroscopically confirmed SLL tears, three tears were detected on FS PD/T2 sequence, five on MEDIC sequence, and all eight were visualized on MR arthrography. The sensitivities of FS PD/T2, MEDIC sequences, and MR arthrography in detecting SLL tears were 37.5%, 62.5%, and 100%, respectively. One arthroscopically confirmed LTL tear was diagnosed on FS PD/T2 sequence, three on MEDIC sequence, and all five arthroscopically confirmed LTL tears were detected with MR arthrography. The sensitivities of PD, MEDIC sequences, and MR arthrography in detecting LTL tears were 20%, 40%, and 100%, respectively. Conclusions: MR arthrography is the most sensitive and specific imaging modality for the evaluation of wrist ligament tears. [ABSTRACT FROM AUTHOR]

Carpal instability represents a heterogenic group of wrist injuries considering the extent of the injury, degree of damage and variability of symptomatology. They can be often unrecognited at the beginning - e.g. in the therapy of simultaneous fracture of distant end of radius. It is often the physiotherapist who primarily draws attention to complaints that become manifest in the course of the patient's rehabilitation after fracture of the distal radius, secaphoid, or treated for vague diagnosis of the wrist distortion which are caused by wrist instability. The establishment of diagnosis may be based on clinical tests, radiologic examination including stress images, magnetic resonance or wrist arthroscopy. An early and precise classification of the injury makes it possible to select a suitable therapeutic procedure and accordingly improve the chance for favorable clinical results. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: It was commonly considered that a non-displaced or minimally displaced isolated scaphoid fracture was mechanically incompatible with a lesion of the scapholunate ligament (SL). However, some authors who described such an association have recently challenged this statement. The aim of this prospective study was to determine, after screw fixation and using arthroscopy, the existence and incidence of lesions of the SL as associated with acute non-displaced or minimally displaced isolated fractures of the scaphoid. Methods: Between December 2009 and January 2011, the study included all patients presenting with an acute non-displaced or minimally displaced isolated fracture of the scaphoid waist, eligible for percutaneous screw fixation and accepting the procedure after informed consent. The surgical protocol included a first retrograde arthroscopically controlled percutaneous screwing of the scaphoid, followed by a second arthroscopy seeking only lesions of the SL. Geissler''s classification was used for the classification of SL lesions. Results: Eighteen patients were included in the study. The mean was 29years. In 17 cases, the scaphoid fracture was due to a low-energy fall, and in 1 case, to a road accident. No SL lesion was evidenced by the diagnostic arthroscopy. Conclusion: Unlike some published reports, we did not observe any SL lesion associated with non-displaced or minimally displaced isolated fractures of the scaphoid. Nevertheless, despite such results and based on the literature, we recommend arthroscopy with percutaneous scaphoid screw fixation, with the triple advantage of providing reduction control, adequate screw fixation verification, and diagnosis of potential associated ligament lesions. [Copyright &y& Elsevier]

Patients presenting with distal end radius fractures may have concomitant carpal instability due to disruption of the scapholunate ligament. This study examined the incidence of static radiographic signs of carpal instability in patients with distal radial fractures before and after fracture treatment. We performed a retrospective radiographic study of 141 patients presenting to Central Middlesex Hospital, London between January 2002-May 2004 with distal end radius fractures. We used abnormal scapholunate angle as the primary indicator of possible carpal dissociation. Abnormal scapholunate angles were noted in 39% of patients at presentation and 35% of patients after treatment with no statistically significant intra-patient variability. Persistent static radiographic signs of carpal instability are high in this subset of patients. The long-term morbidity of persistent wrist instability may be avoided by early radiological diagnosis with clinical correlation to identify carpal ligament injuries and initiate treatment that addresses both the bony and ligamentous components of the injury. [ABSTRACT FROM AUTHOR]

Abstract: We report our preliminary results of arthroscopic dorsal capsuloplasty for chronic scapholunate lesions to obviate the need for an open exposure of the wrist capsule. Twenty-two consecutive patients with scapholunate ligament tears underwent an arthroscopically-assisted dorsal capsuloplasty with or without percutaneous pinning. The mean age of subjects was 36 years (range, 27 to 55 years). The mean preoperative delay was 9 months (range 3 to 24 months). Criteria for surgery were persistent pain over the dorsal radial wrist in the scapholunate region and a positive finding on performing Watson''s test. All patients were reviewed at a mean follow-up of 13 months (range, 7 to 19 months). The range of motion was recovered with a slight limitation in flexion in only four cases. The average grip strength attained was 96% of the contralateral side. The results in terms of pain were excellent. The seven high level athletes resumed practice at the same level as prior to the injury. A longer follow-up is necessary to confirm these encouraging preliminary results. [Copyright &y& Elsevier]

Abstract: Scapholunate ligament tears give chronic instability leading in SLAC. The wrist arthroscopy allows to see the lesions, even in early stage, and to treat them, with a simple K-Wires fixation in acute cases. The patients were operated on in outpatient basis with tourniquet and local general anaesthesia. In acute cases, the scapholunate dissociation was reduced by external and internal manoeuvres. The fixation was done with two pins under arthroscopic and fluoroscopic controls. We report a series of 66 acute cases (less than 45 days after trauma). Forty-four patients were males and 22 females. The average age was 39 years old (range 19–46). Our average follow-up in acute cases was 36 months (range 14–61). According the “Mayo Wrist Score”, we obtained 92 % of good or excellent results. The wrist arthroscopy is the best technique for early diagnosis, guarantee of best functional results. [Copyright &y& Elsevier]

The purpose of this review is to summarize ligamentous injury of the wrist. Triangular fibrocartilage complex (TFCC), scapholunate ligament (SLL), and lunotriquetral ligament (LTL) are crucial to wrist stability. Damage to these ligaments causes changes in bone alignment and altered motion pattern. This may cause pain and eventually osteoarthritis. Imaging techniques of the wrist include conventional arthrography, computed tomography (CT) arthrography, conventional magnetic resonance imaging (Mm), and MR arthrography. Especially, MRI plays an important role in the assessment of TFCC, SLL, and LTL. Therefore, special attention is drawn to normal and abnormal MR imaging appearance of these ligaments in this review. Variety of treatment options dependent on classification of TFCC and ligamentous injury as well as role of imaging in the patient treatment are also discussed. [ABSTRACT FROM AUTHOR]

A 39-year-old patient was presented with, to our knowledge, the first ever diagnosed case of extensor pollicis longus (EPL) tendon rupture as a result of scapholunate (S-L) dissociation. Arthroscopic findings showed that the dorsal aspect of the S-L ligament was ruptured and severe synovitis was revealed around the S-L joint. Direct observation revealed synovium at the rupture site of the EPL tendon. After careful resection of this synovium, an aperture in the S-L joint was observed. Thus, it was considered that the synovium in the S-L joint was connected to the rupture site of the EPL tendon, passing through the dorsal capsule of the S-L joint. The ruptured EPL tendon was reconstructed with extensor indicis proprius tendon transfer, and S-L dissociation was treated with a bone-retinaculum-bone autograft taken from the third dorsal compartment region. [ABSTRACT FROM AUTHOR]

The mechanical properties of the scapholunate ligament have been previously examined in small sample sizes, with ultimate load and occasionally stiffness reported. The present study examined 16 scapholunate ligaments in uniaxial extension at two rates and determined stiffness, ultimate load, and stress relaxation properties. Mean stiffness values of 66.4 ± 28.6 N/mm at an elongation rate of 50 mm/min and 94.5 ± 44.4 N/mm at an elongation rate of 100 mm/min were found. Relaxation behavior, determined by the percent load remaining after 100 s, was found to be 68.1 ± 12%. Mean ligament ultimate loads were 357 ± 110 N (n=8). In eight specimens, failure occurred in bone. Positive correlations were observed between bone mineral density of the hand and ligament stiffness, ligament ultimate load, and bone ultimate load. No correlation was observed between bone mineral density and ligament load relaxation behavior. The results provide a comprehensive understanding of scapholunate ligament biomechanics and demonstrate a relationship between bone and ligament properties. [Copyright &y& Elsevier]

Introduction. To report a new technique for scapholunate ligament reconstruction, using a periosteal flap of the iliac crest. Materials and methods. In 12 patients with static SL instability, a periosteal flap was harvested from the anterior portion of the iliac crest. Following repositioning of the carpals, the flap was fixed to the scaphoid and lunate between an incompletely osteotomised scale at the dorsal horn of the scaphoid and lunate. Pin fixation of the scapholunate (SL) and CL interval secured postoperative reduction for 8 weeks. A forearm plaster cast was worn for 12 weeks. Results. Eleven patients, all male, were available for follow-up at an average of 29 months. The interval between trauma and surgery averaged 15 months. The preoperative SL angle measured 77 deg, CL angle was –10 deg, and SL gap amounted to 5.2 mm. At follow-up, SL angle was 59 deg, CL angle measured –2 deg, and SL gap was 2.1 mm. SL gap, SL angle, and CL angle improved significantly from preoperative to follow-up values. According to the clinical grading system of Green and O’Brian, 6 patients scored in the excellent and good category and 5 in the fair category. Using the radiologic grading system of Gickel and Millender, 9 patients scored as excellent and good, whereas the 2 poor results were due to failure of the technique. Conclusion. The technique enables reduction of the SL angle and SL gap in patients with static reducible scapholunate instability. The initial results are quite encouraging. [ABSTRACT FROM AUTHOR]

Abstract: Scapholunate ligament tears cause chronic instability leading to SLAC. Wrist arthroscopy allows to see the lesions, even at an early stage, and to treat them with a simple K-Wires fixation in acute cases. Patients were treated on an outpatient basis with tourniquet and under regional anaesthesia. In acute cases, the scapholunate dissociation was reduced by external and internal manoeuvres. The fixation was done with pins under arthroscopic and fluoroscopic control. In chronic lesions, after wrist arthroscopy check, an electrothermal shrinkage can be performed in some cases. An arthroscopic classification was created with 4 grades. Wrist arthroscopy is the best technique for early diagnosis, and assures the best functional results. [Copyright &y& Elsevier]