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Scapholunate Ligament Reconstruction Using an Acellular Dermal Matrix: A Biomechanical Study
Amirhesam Ehsan, MD; Adam J. Bakker, MD; Dong G. Lee, MD;  Jerry I. Huang, MD
Hand and Microvascular Surgery, University of Washington, Seattle, WA

Hypothesis: A number of surgical techniques have been described for treatment of chronic scapholunate ligament instability using bone-retinaculum-bone (BRB) autografts, tendon weave reconstructions, and dorsal capsulodesis. We hypothesize that scapholunate ligament reconstruction using an acellular dermal matrix is biomechanically comparable to the native scapholunate interosseous ligament.

Methods: The scaphoid and lunate with the entire scapholunate ligament were harvested from cadaveric specimens. The scapholunate ligament was transected and reconstructed using an acellular dermal matrix (Arthroflex) and 4 micro suture-anchors in 8 specimens (Figure 1). Four specimens were reconstructed using a 1.0 mm thick dermal matrix, while a second cohort of four specimens was reconstructed using a 1.5 mm thick matrix. The specimens were potted in metallic cylinders and tensile testing of both the intact and reconstructed specimens was performed using a MTS servohydraulic system and data acquisition software. The tensile test apparatus applied a distractive load of 0.17 mm/sec (10 mm/min) until the specimens reached ultimate failure. The load-displacement data was obtained and plotted in real-time during the measurement. Failure force, failure displacement, stiffness, and energy to failure were analyzed via post data processing.

Results: All four specimens in the intact group failed at the scapholunate ligament midsubstance. The mean ultimate failure force was 192.0 N with mean stiffness of 86.8 N /mm. In the reconstruction group with 1.0 mm dermal matrices, the mode of failure was at the suture-matrix interface in all specimens, while the 1.5 mm dermal matrix reconstruction cohort all failed at the bone-suture anchor interface.  In the 1.0 mm reconstruction group, the mean ultimate failure force was 78.7 N with mean stiffness of 24.2 N/mm.  In the 1.5 mm dermal matrix reconstruction cohort, the mean ultimate failure force was 101.1 N with mean stiffness of 24.0 N/mm.

Summary Points:

  • Scapholunate ligament reconstruction using acellular dermal matrix and suture anchors demonstrates similar biomechanical properties to previous reconstruction techniques.
  • Scapholunate ligament reconstructions using a 1 mm acellular dermal matrix failed at the suture-matrix interface while reconstructions using 1.5 mm dermal matrix failed at the bone-suture anchor interface
  • Our proposed scapholunate reconstruction technique is a technically simple procedure that warrants clinical investigation as a potential treatment alternative for chronic scapholunate instability.

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