Arthroscopic Scapholunate Synthetic Ligamentoplasty

The scapholunate ligament is made of 3 portions: proximal, volar, and dorsal. The latter is the major stabilizer of the scapholunar pair, and its lesion is bound to cause a destabilization of the carpus, as well as scapholunar diastasis, dorsal intercalated segment instability, then eventually SLAC (i.e., scapholunate advanced collapse) wrist. The healing process of this ligament, either spontaneous or after primary repair with direct suture, is rarely observed and a significant number of patients are diagnosed only at a late stage, thus making an illusion of a maintained stability of the carpus first range. Management then consists of ligamentoplasty. Several open techniques are described to restore stability, but at the cost of a frequent and significant tightening of the wrist. We will introduce here an arthroscopic ligamentoplasty technique completed by a posterior capsulodesis.
Technique Video Video 1 The patient is in the decubitus position, upper limb lies in pronation on an arm table with a pneumatic tourniquet at the basis of the limb, wrist on an arthroscopic tower, right wrist. 00’05: Introduction. 00’22: Ligament check-up and testing. 00’40: Articular check-up. 00’58: Debridement. 01’31: Setting the guide pins. 02’07: Drilling the tunnels. 02’38: Fixation of the SutureTape in the proximal pole of the scaphoid. 03’03: Fixation of the SutureTape in the posterior cornea of the lunate. 03’48: Ligamentoplasty testing through radiocarpal joint. 04’09: Ligamentoplasty testing through midcarpal joint. 04’19: Dorsal capsulodesis.