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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

Abstract 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.

Introduction The scapholunate interosseous ligament binds the scaphoid and lunate together, and is the primary stabilising ligament between these two bones. Scapholunate injuries lead to chronic instability and degenerative arthritis of the wrist. Scapholunate injuries are graded based on the acuity and the severity of the injury. Purpose The paper is a review of various techniques used to repair or reconstruct the scapholunate ligament according to the clinical manifestations, anatomic and pathologic findings. Methods A review of the literature covering this topic is presented. Results Conservative treatment is primarily indicated in stable and partial ligament tears. Arthroscopic treatment is used when immobilization is unsuccessful. Arthroscopically assisted scapholunate reduction and K-wire fixation is commonly used for acute injuries. Primary repair of scapholunate injuries are performed in all tear types using an open approach. Surgical indications depend on the severity of the instability, time after trauma and the presence of degenerative changes. Acute repair of scapholunate ligament injuries remains the gold standard as an earlier intervention provides better results. Acute injuries to the scapholunate ligament require two-four weeks before surgery. Within this period the ligament is often still repairable itself both with or without supplementary capsulodesis procedures; ligament reconstruction is generally preferable in patients with chronic injures. There are many arthroscopic techniques to treat chronic scapholunate injures such as scapholunate ligament primary repair using various types of capsulodesis, tendon graft reconstruction, bone-ligament-bone procedure, various intercarpal fusions and proximal row carpectomy, total wrist fusion and arthroplasty. Conclusion Early diagnosis and management of scapholunate ligament tears are necessary to preserve wrist functions.

The Finite Element Method (FEM) models are valuable tools to create an idea of the behavior of any structure. The complexity of the joints, materials, attachment areas, and boundary conditions is an open issue in biomechanics that needs to be addressed. Scapholunate instability is the leading cause of wrist pain and disability among patients of all ages. It is needed a better understanding of pathomechanics to develop new effective treatments. Previous models have emulated joints like the ankle or the knee but there are few about the wrist joint. The elaboration of realistic computational models of the carpus can give critical information to biomedical research and surgery to develop new surgical reconstructions. Hence, a 3D model of the proximal carpal row has been created through DICOM images, making a reduced wrist model. The materials, contacts, and ligaments definition were made via open-source software to extract results and carry on a reference comparison. Thus, considering the limitations that a reduced model could carry on (unbalanced forces and torques), the stresses that result in the scapholunate interosseous ligament (SLIL) lead us to a bones relative displacement, which support the kinematics hypothesis in the literature as the distal carpal row moves as a rigid solid with the capitate bone. Also, experimental testing is performed, successfully validating the linear strength values of the scapholunate ligament from the literature.

Scapholunate instability is the most common cause of carpal instability. The entity is often missed in practise. If diagnosed early, it may be repairable. However, the later it is diagnosed, the more complicated and difficult the management would be. In this paper we aimed at reviewing the main concepts of the carpal instability and delineating the wide management options of scapholunate interosseous ligament injury discussed in the literature.

Geoffrey Konopka,1 Harvey Chim2 1Department of Orthopaedic Surgery, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA; 2Division of Plastic and Reconstructive Surgery, University of Florida College of Medicine, Gainesville, FL, USA Abstract: 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. Keywords: scapholunate ligament, wrist instability, wrist trauma, carpal dissociation, carpal instability, SLAC wrist

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 There have been numerous studies on surgery of wrist ligament injuries, but a quick assessment reveals few with a high level of evidence (LoE). The primary aim of this study was to categorize the study type and LoE of studies on repair and reconstruction of the scapholunate ligament, the lunotriquetral ligament and the triangular fibrocartilage complex by applying the LoE rating system proposed by the Oxford Centre for Evidence-Based Medicine. The secondary aims were to evaluate the journal- and geographic- distribution of the included studies. An electronic literature search of articles published 1985–2016, in PubMed, Embase, and Cochrane Library was carried out in May 2016 and updated in April 2017. Therapeutic studies written in English were included. The PRISMA checklist guided the extraction and reporting of data. A total of 1889 studies were analyzed, of which 362 were included. Three journals represented 40% of the included studies and American authors dominated. Most studies (97%) had low LoE (IV-V). No studies of LoE I-II were found. There is insufficient evidence to recommend one technique over the other in terms of wrist ligament surgery in clinical practice. There is an immense lack of comparison studies with high level of evidence in the area of wrist ligament repair and reconstruction.

Objective: The aim of this study is to assess the diagnostic value of direct MR arthrography compared to conventional MR imaging in the diagnosis of different pathologic entities affecting the internal ligaments of the wrist mainly the scapholunate and lunotriquetral ligaments. Subjects and methods: This study included 51 patients complaining of chronic wrist pain. Conventional MRI and MR arthrography (MRA) were done in all cases. Results: A comparison of the sensitivity of conventional MRI versus MRA was done by correlating the final diagnosis of each modality with the results of arthroscopy. Regarding complete SLL tears, MRI revealed a SEN, SPE and ACC of 61.54%, 96.77%, and 86.36%, while MRA showed a SEN, SPE and ACC of 92.31%, 100%, and 97.73% respectively, partial SLL tears, un-enhanced MRI revealed SEN, SPE and ACC of 10%, 94.12%, and 75%, while MRA showed 66.67%, 85.71%, and 81.82% respectively, complete LTL tears un-enhanced MRI revealed a SEN, SPE, and ACC of 25%, 100%, and 79.5% respectively, while MRA showed 91.67%, 100%, and 97.73% respectively. Conclusion: MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.

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.