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Arthroscopical Assisted Scapholunate Capsuloplasty: the Role of the Dorsal Capsulo-Scaphlunate Septum (DCSS)
Max Haerle, MD, PhD; Tobias Del Gaudio, MD
Clinic for Hand- and Plastic Surgery, Markgroningen, Germany

Introduction: scapholunate (SL-) dissociation is caused by both a disruption of intrinsic ligament portions, as well as a disturbed interaction in between intrinsic and extrinsic ligaments, which synergistically stabilize the wrist through the dorsal capsulo-scapholunate septum (DCSS). This assumption is based on the fact that interosseous ligament portions between scaphoid and lunate are not strong enough to withstand higher wrist load alone. (Berger et al., 1999) Second, the important role of extrinsic ligaments (DIC, DRCL, palmar STT) in wrist stabilization - preventing both scaphoid flexion and DISI position of the Lunate - has been shown in many studies. (Elsaidi et al., 2004) We surmise that the DCSS is a key structure in maintenance of SL- stability. It attaches dorsally to the carpal bones and - as a septum - is than continued into the intercarpal ligaments. By arthroscopic suture of these septal attachments, which often are disrupted in higher SL- instability, a realignment of the bones can be reached, restoring - at least partially - the original biomechanics, avoiding to harm dorsal intercarpal ligaments.

Materials and Methods: Between 2009 and 2014, we performed a modified dorsal SL-capsuloplasty in 34 patients with clinical and radiological signs of manifest SL- instability. 27 patients were eligible for postoperative follow up: standard clinical assessment for pain, ROM and grip-strength was performed, followed by radiographic assessment of SL-gap, SL- and RL-ankle.

Results: In our collective 63% were men, 37% were women. Geissler III instability of SL-Ligament was found in 77.8%, while 22.2% were classified Geissler IV. After a mean follow up of 1.9 years, on radiographies no statistically significant increase in SL- and RL- angle was found, when compared to preoperative radiographies. Postoperative DASH was 14.5 ħ 16, postoperative Mayo Wrist Score was 82.5 ħ 9.

Conclusion: a modified dorsal SL-capsuloplasty seems to be a valid alternative to open surgical procedures in patients with SL- instability.


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