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Scapholunate Ligament Reconstruction with the Flexor Carpi Radialis Tendon: The Ross Technique
James Dowdell, BA1; Abdo Bachoura, MD2; Sidney M. Jacoby, MD1; Randall Culp, MD1; Mark Rekant, MD1
1The Philadelphia Hand Centers, Thomas Jefferson University, Philadelphia, PA; 2UPMC Hamot, Erie, PA

Hypothesis: Injuries to the scapholunate (SL) joint are the most frequent cause of carpal instability. While acute SL ligament injuries are amenable to ligament repair or capsulodesis, chronic scapholunate dissociation associated with a pattern of dorsal intercalated segment instability often requires ligament reconstruction. The Ross technique utilizes a strip of the flexor carpi radialis (FCR) tendon to reconstruct the SL Ligament. The purpose of this study is to describe the outcomes of this novel technique.
Methods: This was a retrospective review that assessed the efficacy of scapholunate ligament reconstruction in 3 patients with chronic, non-repairable scapholunate ligament tears. The Ross technique uses a strip of the FCR tendon, which is left attached distally. The tendon is passed through bone tunnels in the scaphoid and triquetrum. The tendon is then anchored onto the dorsum of the triquetrum. An interference screw is placed in the triquetrum, and the FCR is brought back and sutured to the capitate using a bone anchor. Pre/post-operative wrist flexion, extension, and grip strength expressed as a percentage of the opposite unaffected hand were assessed. Patients were then contacted and asked to complete a Patient Rated Wrist Evaluation (PRWE) survey and asked their satisfaction with the operation on a 4-point scale. Pre/post-operative radiographs were assessed for scapholunate gap and scapholunate angle. A total of three patients have had this procedure, starting in 2012.
Results: All 3 patients were males, with a mean age of 61 years old. All 3 patients had surgery to the nondominant wrist. The mean postoperative follow up duration was 6 months (range, 3-10 months). The mean pre/postoperative wrist flexion, extension, and grip strength were 58 4, 55 14, and 74 53% and 50, 55, 67 12% respectively. One patient was not satisfied with treatment and scored 35 on the PRWE, while two patients were very satisfied and scored 16 and 17 on the PRWE. Radiographic findings pre/postoperatively showed a scapholunate gap and angle of 5.7 0.6 mm, 61° 7 and 5.7 1.6 mm, 57° 3 respectively, after a mean of 6.7 months post operatively. One patient had the complication of reflex sympathetic dystrophy.
Summary:
- The Ross technique was used successfully to treat two/three patients.
- Pre/post operative radiographs did not show a difference in the scapholunate gap or scapholunate angle.
- Long-term follow up is underway to assess the longevity of this procedure.


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