Long-Term Functional Outcomes of Volar Capsulodesis for Treatment of Scapholunate Interosseous Ligament Injury: A Case Series
Aida K. Sarcon, MD1, Sean R. Cantwell, MD1, Paula A. Pino, MD1, Omar A. Selim, M.B.B.C.h, M.S1 and Steven L. Moran, MD2, (1)Mayo Clinic, Rochester, MN, (2)Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN
Introduction: Scapholunate interosseus ligamentous (SLIL) injuries are common. Most repairs address only the dorsal-SLIL as it is thought to be the primary stabilizer. The volar-SLIL is also important in rotational stability. Our previous cadaveric study detailed a novel volar-SLIL capsulodesis(VSC) that utilized a lunate-based strip of the long radiolunate ligament (LRL). We present our experience in a case series.
Methods: Single-institution observational study (2004-2022) of patients with SLIL injuries and evidence of ruptured volar-SLIL who underwent reconstruction with VSC +/- dorsal capsulodesis (DC). Injuries were classified as static versus predynamic/dynamic injuries (PD/D) and reconstruction type (VSC vs VSC+DC). Demographics and outcomes were retrospectively obtained. The outcomes included postoperative range of motion (ROM), grip strength (GS), radiographic changes, and postoperative complications (SSI and four-corner fusion). The DASH and PRWE functional outcomes were scored prospectively.
Results: 28 patients (15 females and 13 males) with a mean age of 35.1 years (±15.7) met inclusion. Follow-up was 64.3 months (±50.9). Most (26/28) were right-handed. 71.4% of injuries were > 6-weeks old. 14.3%(4/28) used tobacco. 71.4% (20/28) had PD/D versus 28.6%(8/28) with static injuries; 45% (9/20) of patients with PD/D injuries and 50% (4/8) of patients with static injuries had an isolated VSC (Fig 1). At mean 31.5 months (Â±29.1), the wrist ROM (n=13) was a mean flexion of 57Â°, extension of 61Â°, ulnar deviation of 29Â°, and radial deviation (RD) of 19Â° with no difference amongst groups, except for an increased RD ÌŠ in PD/D compared to static injuries (p=0.02). Mean postoperative GS(n=14) was on average 79.9% (±29.9) of the contralateral normal side, with no differences amongst groups. A persistent SL gap (>3 mm) was observed in 37.5%(3/8) with static and 0% of patients with PD/D injuries (p=0.004); these 3 patients had VSC+DC reconstructions. Complications occurred in 3 of 28 patients which consisted of 2 SSIs and 1 four-corner fusion for persistent pain. After 86.9 months (±48.5), 19 patients reported satisfactory DASH (16.4 ±17.8) and PRWE (24.6 ±23.6) scores.
Conclusions: We report long-term functional outcomes following a VSC +/-DC. This procedure was associated with a ~3.5% (1/28) revision rate. Patients reported satisfactory DASH/PRWE scores at 7.2 years postoperatively. VSC appears to be a safe reconstruction option for volar injuries. However, a larger prospective study is warranted for further validation.
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