Mid-to-Long Term Outcomes for Arthroscopic Electrothermal Treatment for Scapholunate Interosseous Ligament Injuries
Matthew B Burn, MD1; Eric J Sarkissian, MD2; Jeffrey Yao, MD2
1Houston Methodist Hospital, Houston, TX, 2Stanford University, Redwood City, CA
Arthroscopic electrothermal treatment of pre-dynamic and dynamic tears of the scapholunate interosseous ligament (SLIL) has shown clinical benefit at short-term follow-up. It is believed to function through denervation in addition to tightening of the injured ligament. The purpose of this study was to evaluate long-term functional outcomes in patients after undergoing this treatment.
A retrospective review of patients undergoing arthroscopic thermal treatment for SLIL injuries (2005 to 2013) was performed. Patients were excluded with less than five years of follow-up, the presence of static SLIL injuries, prior wrist surgery, and concomitant denervation. Symptom resolution, return to activity, postoperative complications, range of motion, grip strength and subsequent treatment were recorded. Each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Modified Mayo Wrist (MMW), and Patient-Rated Wrist Evaluation (PRWE) questionnaires.
Nine patients (mean age 40 years) underwent arthroscopic thermal treatment for pre-dynamic and dynamic SLIL injuries (Geissler Grades 1-3) at a mean 7-year follow-up. Mean grip strength was 99% of the nonsurgical extremity. Wrist motion was near normal with a mean of 76°, 74°, 83° and 86° for wrist flexion, extension, pronation, and supination. QuickDASH improved significantly by a mean 39 points (50 pre- to 11 post-operative, p=0.009). MMW and PRWE scores were 83 and 14, respectively. VAS score was 1.4. One patient received subsequent treatment: a corticosteroid injection at a decade post-operatively. All patients would undergo the operation again.
Our cohort of patients demonstrated excellent objective functional parameters and subjective outcome scores with no need for further procedures at a mean follow-up of 7 years (minimum 5 years). To our knowledge, this is longest follow-up data for this procedure. Our findings confirm that arthroscopic thermal treatment of SLIL injuries is a safe, effective and most importantly durable therapeutic modality for treating these injuries long-term.
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