Extrinisc wrist ligaments radiologic assessment following complete scapholunate ligament rupture
Emil Stefan Vutescu, MD1; Danielle Christine Marshall, BA2; Kevin Chan, MD3; Hollis G Potter, MD4; Steve K Lee, MD2; Scott W Wolfe, MD5; (1)Brown University, Providence, RI, (2)Hospital for Special Surgery, New York, NY, (3)Hospital for Special Surgery, New York City, NY, (4)Radiology and Imaging, Hospital for Special Surgery, New York, NY, (5)Hand and Upper Extremity Service, Hospital for Special Surgery, New York, NY
Introduction: While the scapholunate interosseous ligament (SLIL) is the primary stabilizer of the scapholunate (SL) joint, the importance of the extrinsic ligaments in maintaining carpal stability is not well understood. Missed extrinsic ligament lesions can be an important cause of scapholunate ligament reconstruction failure. The purpose of this study was to radiographically evaluate the presence of secondary extrinsic ligaments injuries in patients with complete SLIL tears.
Methods: Patients ages ?18 who had wrist radiographs and MRI at our institution from 2007-2016 with an intraoperative diagnosis of complete SLIL tear were included in this retrospective study. Ligament injury was evaluated as complete tear, partial tear, plastic deformity (defined as hyperintensity and thickening without partial or complete discontinuity), or intact on fast spin MRI echo sequences by one musculoskeletal MRI radiologist. The following ligaments were evaluated: long radiolunate (LRL), short radiolunate (SRL), radioscaphocapitate (RSC), dorsal radiocarpal (DRC), dorsal intercarpal (DIC), radiopalmar scaphotrapezial (rST) and dorsal scaphotrapezial (dST). SL gap, SL angle, RL angle, dorsal scaphoid translation, presence of DISI (RL angle > 15o) and SL instability (SL angle > 60o) were measured on lateral wrist radiographs by two independent orthopedic surgeons. Categorical data was analyzed using Fisher's Exact test.
Results: Twenty-five patients (22 men) with complete SLIL tear met the inclusion criteria. The mean age was 42 years (range 33-51). Average time between MRI and date of injury was 5.5 months (range 1-21). A complete or partial tear was noted in 39%, 36% and 29% of the LRL, DIC and rST ligaments, respectively. Plastic deformity was identified in 39%, 29%, 29%, 21.4%, and 14% of the LRL, DIC, rST, SRL and DRC ligaments, respectively. In patients presenting with DISI, complete or partial tears were only seen in the rST (25%), dST (43.8%), LRL (31.3%), and DIC (37.5%) ligaments. RSC was found to be intact in all the patients. Scapholunate instability (p = 0.056) and DISI (p = 0.176) show a considerable trend towards significance with LRL partial or complete tear.
Discussion and conclusion: Our results demonstrate that LRL injury can be associated with SL instability and DISI pattern in patients with complete SLIL tear. These results suggest that LRL repair at the time of SL reconstruction may we warranted. We propose a future sequential ligament cutting cadaveric study to further evaluate the effect of LRL sectioning in carpal instability
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