AAHS Home  |  2021 Virtual Portal  |  Past & Future Meetings
American Association for Hand Surgery

Back to 2022 ePosters


Clinical and Radiographic Outcomes of Scapholunate Ligament Tear Reconstruction Techniques: Systematic Review and Meta-analysis
Asif M Ilyas, MD, Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA

INTRODUCTION: Injury to the scapholunate interosseous ligament (SL) is one of the most common causes of carpal instability and post-traumatic wrist arthritis. Surgical management remains challenging due to the complex kinematics of the scapholunate joint, with no consensus on the optimal reconstruction technique. 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 for SL reconstruction in order to better guide management.
METHODS: A total of 42 studies met inclusion criteria using PRISMA guidelines, consisting of 1,172 patients, and was assessed. Standardized data extraction and analysis was performed. Surgical techniques were divided into the following 3 categories: capsulodesis, tenodesis, and bone-tissue-bone reconstruction. The mean of postoperative outcome assessments with standard deviation (SD) were used to calculate pooled standardized mean difference (SMD) with 95% confidence intervals (CIs).
RESULTS: VAS (Visual Analog Scale) score was lowest (least postoperative pain) 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 an average of 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 a mean score of 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 radiographic outcomes (scapholunate gap and scapholunate angle) between surgical techniques.
CONCLUSION: Interpreted in the context of study limitations, existing data demonstrates 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 between techniques, possibly attributable to the heterogeneity of procedures and insufficient preoperative results preventing analysis of differences between mean preoperative and postoperative values. 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.


Back to 2022 ePosters