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Management and Outcomes of Scapholunate Interosseous Ligament Injuries: A Retrospective Review
Julie E. Adams, MD; Eric Rohman; Julie Agel, MA; Matthew D. Putnam, MD
University of Minnesota, Minneapolis, MN

Background: Scapholunate Ligament (SL) injury is the most common cause of carpal instability, and if untreated can progress to arthrosis. The optimal treatment prior to development of arthrosis is controversial. In this study, we describe the procedures used at our center for non-arthritic SL instability, compare the outcomes of different techniques and the effect of patient and injury factors upon outcomes. Based on these findings, we make recommendations for procedure choice based upon patient specific and injury specific factors.
Methods: A retrospective chart review of all patients receiving surgical management of SL injuries without arthrosis or previous intervention was undertaken. Injuries were described as acute vs chronic (> 6wks), graded according to extent, and the presence or absence of concomitant wrist injuries was noted. 82 wrists were included. Surgical procedures included pinning, repair with or without pinning, capsulodesis or ligament reconstruction.
Results: 27 patients were treated in the acute period, and 50 in the chronic period. Complex injuries were more likely to receive acute intervention than isolated injuries (71% vs 14%). Tear depth was not related to the timing of surgery. The most common procedure in the acute period was repair (59%) followed by fixation (26%); in the chronic setting, common procedures were ligament reconstruction (54%), or capsulodesis +/- repair (32%). Acute intervention produced a lower failure rate (4% vs 18%) and a trend towards superior XR outcomes and DASH scores. 86% of isolated injuries were treated in the chronic setting, 24% of which failed. None of the isolated tears treated acutely went on to failure. Of the treatments used in the chronic setting, ligament reconstruction produced superior XR outcomes and similar functional outcomes, with a trend towards lower failure rate (11% vs 25%). Significant risk factors for failure across all patients included Workers Comp (OR 5.2) and chronic intervention (OR 5.7). There was a trend towards higher failure rate in patients who smoked (OR 2.6) and in complete tears (OR 3.4). Patient age and injury to the dominant hand (OR 1.3) were not related to failure.
Discussion: Our series affirms that acute intervention produces superior outcomes, especially in preventing subsequent salvage procedures. If chronic intervention is performed, ligament reconstruction produced superior outcomes in our study. Isolated SL injuries had worse outcomes than complex injuries, likely due to their tendency to be treated in the chronic setting. We theorize that these injuries have less-impressive acute presentations, thereby delaying surgical treatment.


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