Analysis of the Postoperative Outcomes of the Chronic Scapholunate Ligament Instability Managed by Various Surgical Techniques

PURPOSE: To investigate mid-term clinical outcomes of various methods of scapholunate reconstruction for chronic scapholunate instability. METHODS: We retrospectively reviewed 11 patients diagnosed as chronic scapholunate instability, from 2005 to 2013 and followed up for more than one year after surgery. 7 patients were treated with Garcia technique of triple ligament reconstruction, 2, bone-ligamemt-bone repair, and 2, dorsal capsulodesis. Mean age was 42 years (range, 23-61 years). The right side was involved in 6 patients, and the left in 5. The follow-up period averaged 42 months (range, 13-125 months). The postoperative functional outcomes were assessed with Modified Mayo wrist score (MMWS), disability of the arm, shoulder and hand (DASH) score and range of motion. The postoperative radiologic results were analyzed with the change of scapholunate angle and distance. RESULTS: The mean MMWS score improved from 65 preoperatively to 77 postoperatively (p=0.072). The mean DASH score improved from 29.4 (range, 18.3-43.3) preoperatively to 12.7 (range, 0-38.3) postoperatively (p=0.003). The dorsiflexion increased from 67° to 78°, the volar flexion decreased from 51° to 45°, the supination increased from 69° to 88°, and the pronation increased from 62° to 66°. The SL angle changed from 55° preoperatively to 51° postoperatively, the mean SL distance changed from 3.4 mm preoperatively to 1.7 mm postoperatively. CONCLUSION: The chronic scapholunate instability is amenable to various techniques and postoperative functional outcomes improved satisfactory.

Radiological Analysis of the Scaphoid Shift Test / 대한정형외과학회잡지

PURPOSE: To evaluate the carpal behaviors during the scaphoid shift test and to compare the results of clinical examination to findings of the radiological analysis. MATERIALS AND METHODS: Sixty patients who suffered from chronic wrist pain were evaluated clinically and radiologically when the scaphoid shift test was performed. Clinical findings were graded on the basis of the degree of palpable scaphoid shift and degree of pain on the dorsal aspect of the wrist. The scaphoid shift test was repeated under fluoroscopy. Radiological paramenters of displacement (scaphoid-lunate displacement index and scaphoid-radius displacement index) and rotation (change of scaphoid-radius angle and lunate-radius angle) were measured. Radiological parameters were evaluated according to the degree of clinical severity. RESULTS: Degree of clinical shift during the test was significantly associated with both scaphoid-lunate displacement and scaphoid-radius displacement, whereas degree of pain was significantly associated with scaphoid-lunate displacement,.not scaphoid-radius displacement. Patients who complaint pain during the test showed significantly higher radiological scaphoid-lunate displacement index when compared to those who did not have pain, but not significantly different scaphoid-radius displacement index. CONCLUSION: This study revealed that the presence of pain reflected the instability between the scaphoid and lunate rather than the degree of dorsal scaphoid shift. We conclude that radiological observation during the scaphoid shift test would be helpful in diagnosing the pathologic scapho-lunate instability.