Carpal instability with some of its clinical manifestations had been described by Destot [
16] in 1926, but the term „instability” was introduced by Dobyns [
17] in 1967. In scapholunate dissociation the capitate migration down into the scapholunate joint tends to create a gap between the scaphoid and the lunate. This will cause extension of the lunate and flexion of the scaphoid, giving rise to an increased scapholunate angle as a result of scapholunate interosseous ligament attenuation. This is also accompanied by an increased capitolunate angle. An additional factor is the increased ulnar translation of the lunatotriquetral complex due to the release of the scapholunate interosseous ligament. Acute injuries can practically always be improved without surgery if standard x-rays and stress views show no obvious signs of instability [
13‐
15]. Each method of surgery treatment requires a level of experience. If the result of injury is partial tear of the SLIL, it will represent occult or predynamic instability [
18,
19]. For these injuries, most specialists recommend starting the treatment with splinting and/or casting [
19,
20]. Arthroscopic debridement with or without pinning can be an option for patients for whom the initial conservative treatment failed to succeed. With complete SLIL tears, immobilization does not reduce or prevent scapholunate dissociation [
19]. Significant force occurs at the scapholunate interval on wrist loading. Options for acute management of these tears include direct repair with or without dorsal capsulodesis or arthroscopic debridement, reduction, and pinning. For chronic SL instabilities variable tendon reconstruction techniques and tenodesis have been described and tested with variable success, but when Brunelli and Brunelli [
21] presented their method in 1995 it was a breakthrough in treatment of scapholunate instability, not because of its effectiveness in treatment of the scapholunate dissociation, but because it restricted and prevented the occurrence of rotatory subluxation of the scaphoid. It limited the flexion movements of the wrist, though, therefore three years later the procedure was modified by Abbeele [
22] and became the best applicable technique in cases of dynamic scapholunate instability with rotatory subluxation of the scaphoid. Garcia-Elias described his own modification [
15] of this procedure in 2006 and called it the three-ligament tenodesis for treatment of scapholunate dissociation. since 1995 only one case of avascular necrosis of the scaphoid [
23] has been mentioned in available literature When logically reasoning about anatomical relationship between the scaphoid and the lunate, the new method presented here will restore better functioning of scapholunate ligament complex. Maintaining the distal part of the scaphoid in the axis of scapholunate complex by anchoring it, the free tendon graft will prevent rotatory subluxation of the scaphoid without the need of involvement of dorsal extrinsic ligaments as it is happening in modified Brunelli procedures. Since 1998, when Abbeele introduced his own modification to Brunelli procedure, we have found less than 400 cases treated with this technique [
15,
21‐
28]. The largest number of patients treated with this method were presented by Talwalker [
25]. Most authors who revealed the results of implementing this technique unanimously agree that this is a method suitable for carefully selected cases; in addition better results were obtained in case of dynamic instabilities. Wrist range of motion got decreased in the range of 20% in dynamic instabilities to even 50% in static ones. The grip strength was also reduced even to 30% when compared to healthy wrists. Some publications informed of even better results than these after performing 4-corner fusion procedure [
28].
Although this is not a clinical study, it shows that the mechanism of the new technique can restore the correct anatomical topography of scapholunate ligament complex with no deterioration of wrist movements. We also believe that in case of scapholunate instability with DISI deformity, the proposed modification of Brunelli technique could improve long-term results of surgical treatment.