Partial Scapholunate Ligament Injuries Treated With Arthroscopic Debridement and Thermal Shrinkage

doi:10.1016/j.jhsa.2005.05.013

The Journal of Hand Surgery

Volume 30, Issue 5, September 2005, Pages 908-914

https://doi.org/10.1016/j.jhsa.2005.05.013 Get rights and content

Purpose

To present the early results of arthroscopic debridement and thermal shrinkage using radiofrequency probes for partial (Geissler grades I and II) scapholunate (SL) interosseous ligament injuries of the wrist.

Methods

Sixteen patients with a mean age of 34 years (range, 18–54 y) presenting with chronic dorsoradial wrist pain unresponsive to initial conservative treatment for a mean period of 12 weeks were included in this study. No patient showed radiologic signs of static dissociation (SL interval, <3.5 mm; mean SL angle, 49°) before surgery. Diagnostic arthroscopy showed a partial SL tear in 14 patients and redundancy of the ligament in 2. Partial SL tears involved the membranous (proximal) and volar part of the ligament. All lesions were debrided and treated with thermal shrinkage using a bipolar radiofrequency probe.

Results

The mean follow-up period was 19 months (range, 9–34 mo). Fourteen patients experienced substantial pain relief whereas in 2 the pain remained unchanged. Eight patients were completely pain free. The mean flexion-extension arc was 142° and the mean grip strength was 78% that of the unaffected side. No patient showed radiologic signs of arthritis or static or dynamic instability after surgery (SL interval remained <3.5 mm; mean SL angle, 53°). Based on the modified Mayo wrist score there were 8 excellent, 6 good, 1 fair, and 1 poor result.

Conclusions

Partial SL ligament tears can be a source of radial-sided wrist pain. Scapholunate ligament debridement and thermal shrinkage effectively provided pain relief for most of the patients treated. Stability was maintained radiographically. No complications were noted from the use of radiofrequency probes. These reasonably favorable short-term results should be viewed cautiously. A longer follow-up study is necessary to determine the ultimate efficacy of this procedure.

Section snippets

Materials and Methods

A retrospective review of the records of patients who had had arthroscopic debridement and thermal shrinkage of the SL ligament in the practice of the senior author (D.G.S.) identified 22 such procedures in 21 patients. In 3 patients the primary complaint was ulnar-sided wrist pain; a concomitant triangular fibrocartilage complex (TFCC) tear was debrided and 1 of these patients had bilateral ulnar-shortening osteotomies. These patients were excluded from this study because the TFCC injury was

Results

The mean follow-up period was 19 months (range, 9–34 mo) (Table 1). Fourteen patients experienced substantial pain relief whereas in 2 the pain remained unchanged. Eight patients were completely pain free. Six patients reported pain only with strenuous activities; among them 2 recalled a new injury to the wrist. Overall pain visual analog scale scores improved significantly (p < .001) both during rest and during activities. The mean flexion-extension arc was 142° and the mean grip strength was

Discussion

The most consistent finding of this study is symptomatic relief. Although there are limitations to retrospective visual analog scale pain assessment, 14 of 16 patients reported substantial pain relief after arthroscopic debridement and thermal shrinkage of the partially torn SL ligament. Patients with a concomitant TFCC tear and ulnar-sided wrist pain were excluded from this study to avoid overlap of the 2 procedures. This study verifies the view that a partially torn SL ligament can be a

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Twenty-three subjects (26 wrists) completed the program. Pain on visual analog scale improved by 5.1 cm and total pain score improved from 14.4/20 to 19.5/20. Total performance score reached 39/40, which indicated near-normal wrist function. Power grip and pinch grip increased by 22.3% and 17.8%, respectively. The physical component scale of the Short-Form 12 item questionnaire showed significant improvement, while the mental component scale did not. Overall adherence was fair.
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L’instabilité scapho-lunaire est la plus fréquente des instabilités du carpe. La déficience complète du complexe ligamentaire scapho-lunaire peut entrainer douleur, impotence fonctionnelle et arthrose par collapsus du carpe en l’absence de traitement. Le but d’une intervention pour instabilité scapho-lunaire chronique (vue à plus de 6 semaines) avant l’apparition d’arthrose est de corriger l’instabilité afin de diminuer la douleur sans perdre trop en mobilité et d’arrêter ainsi le processus dégénératif arthrosique à long terme. Parce que de nombreuses techniques de reconstruction du ligament scapho-lunaire ont été décrites et parce que chaque patient n’est pas forcément candidat à une chirurgie lourde, nous avons essayé de répondre à la question: quel est le traitement le plus adapté au patient à chaque stade de l’instabilité scapho-lunaire chronique? Ce travail passe en revue l’anatomie du complexe scapho-lunaire, ses propriétés biomécaniques et les moyens de diagnostic actuels de dépistage l’instabilité scapho-lunaire. Un algorithme de traitement, basé sur le degré d’instabilité et sur la demande fonctionnelle du patient, est proposé.
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This study identified 14 active duty patients who met inclusion criteria, mean age 29 years. Six were male and 9 of 14 had concomitant arthroscopic occult dorsal ganglion cyst removal at the time of the index surgery. The severity of SL instability was staged using the Geissler classification; the cohort distribution for stages I, II, and III was 3 patients, 10 patients, and 1 patient, respectively. At 2-year follow-up, the return to duty rate was 12 out of 14 and the return to push-ups activity rate was 11 out of 14. Pain with activities by visual analog scale was reduced from 7.1 to 1.4.
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Original articleWristPartial Scapholunate Ligament Injuries Treated With Arthroscopic Debridement and Thermal Shrinkage

Purpose

Methods

Results

Conclusions

Section snippets

Materials and Methods

Results

Discussion

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Hand Clin

Orthop Clin North Am

J Hand Surg

J Hand Surg

Hand Clin

J Shoulder Elbow Surg

Arthroscopy

J Hand Surg

Original article
Wrist
Partial Scapholunate Ligament Injuries Treated With Arthroscopic Debridement and Thermal Shrinkage