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American Association for Hand Surgery

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Clinical and Radiographic Outcomes of Scapholunate Ligament Tear Reconstruction Techniques: A Systematic Review and Meta-Analysis
Meagan Wu, MA, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA and Asif M Ilyas, MD, MBA, Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA

Background: Injury to the scapholunate interosseous ligament (SLIL) is one of the most common causes of carpal instability. Surgical management remains challenging with no optimal technique identified for treating chronic SLIL disruption. The goal of this meta-analysis was to comparatively review the available evidence of clinical, radiographic, and patient-reported functional outcomes between common surgical techniques in order to better guide management of SLIL injuries.
Methods: Using PRISMA guidelines, 1,172 patients from 42 included studies were assessed. Surgical techniques were divided into the following categories: capsulodesis, tenodesis, and bone-tissue-bone reconstruction. Standardized data extraction and analysis were performed to compare postoperative pain, grip strength, range of motion, scapholunate interval and angle, and patient-reported functional outcomes between the three technique groups.
Results: VAS (Visual Analog Scale) score for postoperative pain was lowest in the bone-tissue-bone group at 0.9, compared to 2.3 in the tenodesis group and 2.6 in the capsulodesis group (P<0.05). Bone-tissue-bone reconstruction had the highest percentage of "excellent" functional outcomes at 64.5%, followed by tenodesis at 28.1% and capsulodesis at 12.3% (P<0.0001). DASH/QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was best in bone-tissue-bone patients at 9.7, followed by 19.4 in tenodesis patients and 24.4 in capsulodesis patients (P<0.0001). PRWE (Patient-Rated Wrist Evaluation) score was best in tenodesis patients at 37.8, compared to 25.6 in capsulodesis patients and 16.3 in bone-tissue-bone patients (P<0.05). There were no statistically significant differences in grip strength, range of motion, or scapholunate gap and angle between techniques.
Conclusions: Existing data demonstrate some benefit of bone-tissue-bone reconstruction over capsulodesis and tenodesis in pain reduction and functional improvement of the injured wrist. No significant differences among radiographic outcomes could be ascertained. This review provides a reference for future studies as well as highlights the need for higher-quality multi-center trials with longer-term follow-up and more standardized outcome measures.


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