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Scapholunate Ligament Repair

 scapholunate ligament tear MRI
  • synonyms:

Scapholunate Ligament Repair CPT

Scapholunate Ligament Repair Anatomy

Scapholunate Ligament Repair Indications

  • Acute scapholunate instability
  • Subacute scapholunate instability

Scapholunate Ligament Repair Contraindications

  • Radioscaphoid arthritis
  • Capitolunate arthritis
  • Chronic scapholunate instability

Scapholunate Ligament Repair Alternatives

Scapholunate Ligament Repair Pre-op Planning / Special Considerations

Scapholunate Ligament Repair Technique

  • Pre-op antibiotics.
  • Supine position with hand table.
  • Anesthesia (regional or general)
  • EUA compare to uninjured side.
  • Touniquet high on arm.
  • Consider Wrist Arthroscopy to confirm diagnosis and examine for arthritic changes.
  • Dorsal longitudinal incision just ulnar to Lister's Tubercle.
  • Step-cut insicion in the extenosr retinacular over the 4th dorsal compartment.
  • Consider posterior interosseous nerve neurectomy.
  • Transverse incision in capsule just proximal to the dorsal intercarpal ligament. Extend the incision proximally and radially along the radial aspect of the radiocarpal ligament as needed.
  • Indentify the scapholunate interosseous ligament. It is typically avulsed from its scaphoid insertion.
  • Evaluate the dorsal intercarpal ligament for injury to its lunate of scaphoid insertions.
  • Evaluate for any chondral injury.
  • Reduce scapholunate joint anatomically. The scaphoid is typically flexed and the lunate is typically extended. K-wires may be needed to aid in the reduction.
  • Place 1or 2 0.045 k-wires from radial to ulnar across the scapholunate joint and 1 -.045 K-wires from ulnar to radial across the triquetrolunate joint to maintain the reduction.
  • Place mini-suture anchors (2.0-3.0mm) to anatomically restore the scapholunate interosseous ligament and dorsal intercarpal ligament.
  • Irrigate.
  • Repair the capsule and extensor retinaculum.
  • Repair in layers.

Scapholunate Ligament Repair Complications

  • Loss of reduction
  • Pin track infection

Scapholunate Ligament Repair Follow-up care

  • Long-arm splint in pronation for 4-6 weeks, with frequent follow-up xrays to assess reduction.
  • At 6 week follow-up change to short-arm splint.
  • K-wires are removed at 10-12weeks.
  • Consider occupational therapy if stiffness continues one month after pin removal.

Scapholunate Ligament Repair Outcomes

Scapholunate Ligament Repair Review References

Viegas SF in Master Techniques The Wrist, 2nd Ed 2002

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