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Outcomes of Scapholunate Ligament Repairs and Reconstructions: Internal Brace Augmentation Shows Limited Success
Anna L Gorsky, B.S., Kier M Blevins, MD, Krishna N Chopra, B.S., Michael B Gottschalk, M.D.; Eric R. Wagner, MD, MS
Emory University School of Medicine, Atlanta, GA
Introduction: Management of wrist ligament injuries with internal brace repair remains a difficult and controversial subject. We believe that this technique does not provide suitable outcomes for patients with scapholunate (SL) ligament or perilunate injuries, and other surgical options should be explored.
Materials & Methods: Following Institutional Review Board approval, a retrospective chart review was performed for patients who underwent SL reconstruction with internal brace (IB) repair between 2019 and 2021 at our institution. Patients were divided into two cohorts: those with isolated SL reconstruction (standard IB) and those with a concurrent perilunate repair (PL/IB). Patients were then contacted postoperatively for patient-reported outcome measures (PROMs) and wrist range of motion (ROM).
Results: 14 patients with an average follow-up of 47.6 months (range: 35-69) were divided into the two cohorts (standard IB: n=10, PL/IB: n=4). 13 patients (92.9%) had an acute injury. Visual analogue score (VAS) pain and wrist subjective value (WSV) improved moderately postoperatively. Postoperative ROM was not significantly impacted in either group, with slight improvements in flexion, pronation, and supination and relatively stable extension and radial and ulnar deviation compared to preoperative ROM. There were no significant differences in postoperative ROM or PROMs (VAS pain, WSV, QuickDASH, PRWE, satisfaction) between groups. Patients with isolated SL injuries were not highly satisfied, and a majority said they would undergo a different revision option if available. Patients with concomitant SL and perilunate injuries reported slightly better functional and subjective outcomes than those with isolated SL injuries, though many patients also expressed minimal satisfaction and interest in a different revision option if available.
Conclusions: Scapholunate ligament reconstruction with internal brace augmentation led to variable clinical outcomes, inferior to many other methods of SL reconstruction. While patients with concomitant perilunate injuries fared slightly better, our data suggests that overall, SL reconstruction with internal brace produces variable outcomes without consistently improving patients' wrist function, with variable patient satisfaction scores. Future studies should include a larger sample to better elucidate specific indications for this procedure.
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