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Scaphoid Dorsal Translation after Scapholunate Ligament Injury and extrinsic ligament injury: a Cadaveric Study
Jordan Carolina Villa, MD; Jeffry Stepan, MD; Jelle van Der List, MD; Scott W Wolfe, MD; Steve K Lee, MD
Hospital for Special Surgery, New York, NY
Introduction: Injury of the scapholunate ligament (SLIL), the primary stabilizer of the scapholunate joint, is associated with altered carpal motion, joint surface incongruity and progression to arthritis. Furthermore, extrinsic ligaments are considered to confer important secondary stability to the proximal carpal row. The purpose of this study was to radiographically assess scaphoid dorsal translation after selective sequential sectioning of the SLIL and extrinsic ligaments of the wrists and to determine which radiograph view has the greatest utility for demonstrating scaphoid dorsal translation.
Methods: 6 cadaveric wrists with intact ligaments confirmed on physical examination, radiographs and arthroscopy. SLIL section was performed arthroscopically. Extrinsic ligaments were sectioned arthroscopically (radioscaphocapitate and radiolunate) and through mini-open incisions (scaphotrapeziotrapezoid, dorsalradiocarpal and dorsalintercarpal ligaments). Radiograph measurements after weight loading at baseline, after SLIL injury and after extrinsic ligament injury included: scapholunate (SL) gap, and scapholunate (SL), radiolunate (RL) and radioscaphoid (RS) angles. In addition scaphoid dorsal and vertical translation were measured in true lateral and flexion lateral views. Scaphoid translation was defined as the distance (mm) between the centers of the best fit circles for (1) the scaphoid proximal articular surface and (2) the scaphoid fossa, using the external palmar cortex of the radius as the orientation axis. Measurements were done using Image J Software. Kolmogorov-Smirnov test was used to assess normal distribution in all groups and ANOVA and LSD Post Hoc analysis to evaluate differences between groups.
Results: SLIL injury resulted in significant differences when compared to baseline measurements (intact hand) on SL gap on PA (0.965mm)(p=0.012), SL angle (13.07mm)(p=0.008) and RS angle (11.23 mm)(p=0.028). When comparing extrinsic ligaments injury with baseline wrist, a significant increased on scaphoid dorsal translation on true lateral (1.36mm)(p=0.023) and flexion lateral views (-2.74mm)(p=0.013) was observed. Furthermore, when comparing extrinsic ligament injury versus SLIL injury, there was a significant difference on SL gap fist (0.77 mm) (p=0.04) and a trend on SL gap (0.71 mm) (p=0.051). Comparing dissection of SL and extrinsics ligaments with the intact hand, differences are seen on all measurements except RL angle.
Discussion/Conclusion: acute SLIL injury does not cause dorsal scaphoid translation on loaded true lateral radiographs, however dorsal translation is significant after section of the extrinsic ligaments. Similarly, SLIL injury is not associated with dorsal scaphoid translation on flexion lateral views. Extrinsinc ligament injury shows significant ventral translation of the scaphoid on flexion lateral views. SL gap has the greatest utility to evaluate SLIL and extrinsic ligament injury.
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