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Scapholunate Interosseous Ligament Reconstruction: A Systematic Review and Meta-Analysis
Lauren T Daly, MD1; Michael C. Daly, MD MSc2; Amin Mohamadi, MD2; Neal Chen, MD2
1University of Massachusetts, Worcester, MA; 2Massachusetts General Hospital, Boston, MA
Introduction: Multiple surgical techniques have been described for the treatment of scapholunate interosseous ligament (SLIL) dissociation. However, the volume of evidence describing these procedures makes it difficult to understand if there is an advantage to one procedure over another. We performed a systematic review and meta-analysis of current literature to test the null hypothesis that there are no radiographic or clinical differences between SLIL reconstruction techniques.
Methods: We identified 229 articles reporting outcomes of SLIL reconstruction. Of these, 28 studies (510 wrists) met eligibility requirements, and reported sufficient data on outcomes to be included in the study. The mean and standard deviation of pre-operative and follow-up assessments, including scapholunate gap (SLG) and scapholunate angle (SLA), were used to calculate pooled standardized mean difference (SMD) with 95% confidence intervals (CI). Due to high study heterogeneity, we used random-effects models including Hedges' g for standardized mean difference and 95% CI.
Results: Tendon graft reconstruction demonstrated an SMD between pre-operative and follow-up SLG of 1.001 (95% CI: 0.599-1.403), which represents significant improvement compared to capsulodesis with a SMD of 0.219 (95% CI:-0.188-0.625) (p=0.007) (Figure 1). For SLA, tendon graft reconstruction demonstrated a SMD of 0.706 (95% CI: 0.385-1.027) which was significantly better than capsulodesis with a SMD of 0.108 (95% CI:-0.215-0.430) (p=0.01) (Figure 2). Tendon graft reconstruction significantly improved the radiographic outcomes of SLG and SLA in comparison to capsulodesis (p=0.007 and p=0.01, respectively). For other radiographic or clinical outcomes, there were not enough reported data to calculate a pooled effect size. There was significant heterogeneity in the included studies with an I squared of 86% and 84% for SLG and SLA, respectively. The funnel plot showed few potential missing studies. However, Duval and Tweedie's trim and fill and Orwin's fail-safe did not indicate that missing studies would have changed the results significantly.
Conclusion: Comparing pre-operative to follow-up radiographic measurements, tendon graft reconstruction demonstrated significantly improved scapholunate gap and scapholunate angle relative to capsulodesis. ¥ Meta-analysis of functional or clinical outcomes was not possible with the existing data within published studies due to insufficient data reporting and high heterogeneity of reported outcomes
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