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American Association for Hand Surgery

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Scapholunate Interosseous Ligament Complex Complete Tear Is Associated With Injury of the Long Radiolunate, Dorsal Intercarpal and Dorsal Radiocarpal Ligaments
Emil Stefan Vutescu, MD1, J. Elliott Brown, MD1, Edgar Garcia-Lopez, MD1, Julie Katarincic, MD1, Manuel F. DaSilva, MD2 and Joseph Gil, MD1, (1)Brown University, Providence, RI, (2)Orthopaedic Surgery, The Warren Alpert Medical School at Brown University/Rhode Island Hospital, Providence, RI

Introduction/Hypothesis: Current biomechanical data suggests that scapholunate interosseous ligament complex (SLIL) dissociation occurs in the setting of incompetence or injury to volar and dorsal secondary stabilizing ligaments of the wrist. The purpose of this study was to evaluate the presence and severity of these secondary stabilizing ligaments on magnetic resonance imaging (MRI) in patients with complete scapholunate interosseous ligament complex tears. We hypothesized that complete SLIL tears are significantly associated with lesions to long radiolunate ligament (LRL), dorsal intercarpal ligament (DIC) and dorsal radiocarpal ligament (DRC).

Methods: Patients ages ≥18 who had wrist MRI at our institution from 2010-2020 were included in this retrospective study. Patients with an intraoperative diagnosis of complete SLIL tear were compared to a matched control group with intact SLIL on wrist MRI. Ligament injury was evaluated on coronal, axial and sagittal MRI sequences and described as complete tear, partial tear, edema (defined as hyperintensity without partial or complete discontinuity), or intact by one musculoskeletal MRI radiologist (Figures 1-7). The following ligaments were evaluated: long radiolunate (LRL), short radiolunate (SRL), radioscaphocapitate (RSC), dorsal radiocarpal (DRC), dorsal intercarpal (DIC). Categorical data was analyzed using Pearson-Chi square test.
Results: Twenty-five patients with complete SLIL tear met the inclusion criteria. The mean age was 45 years (range 18-72) and average time between MRI and date of injury was 11 weeks (range 1-48) (Table 1). A complete or partial tear was noted in 88%, 40%, 36%, 12% and 8% of the DIC, LRL, DRC, RSC and SRL, respectively. Edema was identified in 20%, 8%, 4%, 12% and 0% of the LRL, DIC, DRC, RSC and SRL ligaments, respectively (Table 2). Compared with controls, patients with complete SLIL tears had a severe injury (described as partial or full tear) of the LRL (p<0.005), DIC (p<0.005) and DRC (p<0.05). No differences in severity of tears of the SRL (p=1.00) and RSC (p=3.6) were noted.

Discussion and Conclusion:
LRL, DIC, and DRC injuries are associated with complete SLIL tears. Our results suggest that SLIL injury should be evaluated in the context of additional pathology to volar and dorsal secondary stabilizing ligaments of the wrist. MRI evaluation of these secondary ligaments may assist in the clinical management of patients with SLIL tears.

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