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Results of Arthroscopic Reduction Association of the Scapholunate Joint
Steven Koehler, MD; Sara Guerra, MD; Michael Hausman, MD
Department of Orthopaedic Surgery, Mount Sinai Medical Center, New York, NY

Introduction: The reduction association scapholunate technique was described as an open technique that creates a fibrous non-union between the scaphoid and lunate for treatment of scapholunate interosseous ligament tears; but, a more recent alternative technique includes the use of an arthroscope for fixation. We hypothesize that Arthroscopic Reduction Association of the Scaphoid and Lunate (ARASL) is an optimal technique for scapholunate ligament injuries that decreases wrist pain and improves function.

Materials & Methods: 18 patients with scapholunate injuries (including grade I SLAC) who had undergone ARASL by the senior author were included. Post-operative pain score, DASH, range of motion (ROM), grip strength and radiographic parameters were calculated. Statistical significance was calculated using a two-tailed t-test and the Fisher exact test.

Results: The average follow-up time was 3 years. Postoperatively there was noticeable reduction in average SL angle, SL joint diastasis and carpal height ratio. Postoperative average VAS was 2.5 and average DASH score was 8. The average postoperative grip strength difference was 15% less in the operative wrist compared to the nonoperative wrist. The average arc of postoperative range of motion was 103o. There were 8 complications (44%). 3 complications were attributable to technical mistakes. 5 patients had SL joint widening and 1 patient had windshield-wipering of the hardware. 2 patients underwent revision ARASL and 2 patients had a PRC. Overall survival was 78% of the index surgery.

In the patients without SLAC wrist, the SL angle, SL joint diastasis, carpal height ratio, DASH and VAS were not significantly improved. There was 1 complication (11%), which was asymptomatic SL gap widening. No patient required additional surgery and postoperative survivorship was 100%.

However, SLAC was a statistically significant risk factor for complications and revisions. Furthermore, a preoperative gap greater than 5mm was predictive of SL gapwidening and complications.

ARASL patients maintain a high average arc of wrist motion.
Patients with SLAC had the majority of complications and all of the revision surgeries.
SLAC was a statistically significant risk factor for complications and revisions.
A preoperative gap greater than 5mm is predictive of SL gap widening and complications.
Perfect technique is imperative for a chance at success for this procedure. Three of our complications were due to technical errors.
Our complications offer insight into the technical aspects of ARASL.
The ARASL technique is a very promising surgical option for well-selected patients with scapholunate injuries.

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