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Tri-ligament Tenodesis; Speeding up Recovery
Reinier Feitz, MD1; Eva Beek, MD2; Harm Slijper, Phd1; Sjoerd Kamminga, MD2; Thybout Moojen, MD, Phd3
1Xpert Clinic, Hilversum, Netherlands; 2Hand en Pols centrum, Diakonessenhuis Zeist, Zeist, Netherlands; 3Hand surgery, Xpert Clinic, Hilversum, Netherlands

Purpose: Management of chronic scapholunate (SL) instability remains a controversial subject. The purpose of this prospective study was to evaluate our provisional results at one year follow-up after performing a ‘tri-ligament tenodesis’ without use of internal fixation in patients with static or dynamic SL instability. 

Methods: Between January 2007 and July 2009 a tri-ligament tenodesis was performed in 32 patients. No type of internal fixation was used and a short arm cast was applied for a total of four weeks only. Range of motion and grip strength were measured on both the injured and non-injured side preoperatively and twelve months after surgery in 24 patients. Functional impairment (DASH questionnaire) and pain (Visual Analogue Scale) were also recorded preoperatively and at 12 months follow-up. 

Results: At twelve months follow-up we recorded in our group of 24 patients a mean VAS score of 1.8, a decline of 65% when compared to preoperative scores. Mean DASH score was 14.8, a decline of 53%. We recorded a significant decrease in wrist flexion (56 to 41 degrees, p-value <0.001) with preservation of preoperative values of wrist extension, radial and ulnar deviation. Grip strength was not influenced by surgery. Patient satisfaction was high (>90%) and no major complications occurred.

Conclusion: Results at one year follow-up show that the use of the tri-ligament tenodesis technique with a shortened period of cast immobilisation is an effective treatment of a reducible scapholunate instability when compared to existing methods of treatment. This method results in a significant decrease of pain with preservation of wrist function and with minor complications. 

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