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Long Term Outcomes of Capitohamate Bone-Ligament-Bone Grafts for Scapholunate Dissociation
Robert J. van Kampen, MD; Steven L. Moran, MD; Richard A. Berger, MD, PhD;
Mayo Clinic

Introduction: One of the more recent treatment options for scapholunate dissociation is the use of bone-ligament-bone grafts. Besides some technical papers and preliminary data no long-term outcomes have been published. We hypothesize that the capitohamate bone-ligament bone (BLB) graft restores carpal alignment and has a good long-term clinical and radiological outcome.

Methods: The medical records of patients treated with capitohamate BLB grafts for scapholunate dissociation were retrospectively reviewed. 31 patients had undergone a capitohamate BLB graft (one bilateral). Eight were excluded because of additional procedures. 23 patients were sent a DASH and PRWE questionnaire and were asked to come back for a wrist exam and x-rays. 13 patients returned the questionnaire and 12 wrists (one bilateral) were seen back. Range of motion (ROM), grip strength, pain, complications, return to work status and radiographic parameters of scapholunate angle, diastasis and radiolunate angle were documented.

Results: The average age at surgery was 48.7 years. All had a complete SL tear, one dorsal partially intact. The average follow-up was 9.2 years (5.0 - 11.7). The average ROM compared to the contralateral side changed from 84% preoperatively to 75% at latest follow-up. The average grip strength was 65.9% preoperatively and 66.8% postoperatively. Eight patients had a post-operative VAS score of 0, which could go up to 3 with heavy activities in three cases. One had a VAS score ranging from 1 to 4. Three reported work limitations with a VAS of 3 or higher at rest, which could go up to 10. One of these had an early k-wire removal due to pin-site infection; another had a questionable history of inflammatory arthritis and decided to undergo a salvage procedure. The preoperative Mayo Wrist Score was 66.8 (45-80) and postoperatively 70.9 (40-95). The average PRWE was 20.46 (0-54), average DASH 16.25 (0 – 49.2), average Work DASH 13.025 (0 – 100). Four patients had no signs of arthritis. Four had early stage radiocarpal arthritis. Two patients had midcarpal arthritis. One mild scaphotrapeziotrapezoid arthritis, one significant radiocarpal arthritis and lunate translocation.

Conclusion: Bone ligament bone reconstruction resulted in improvement in wrist pain, but decrease in motion. Radiologic progression of arthritis was not prevented. These outcomes are comparable to mid-term results of other SL reconstructive options.

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