title: Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft.
abstract: This study was designed to evaluate the use of a locally available bone-retinaculum-bone graft in the reconstruction of the completely torn scapholunate (SL) ligament. Nineteen consecutive patients (14 with dynamic instability and 5 with static instability) underwent SL ligament reconstruction using an autogenous bone-retinaculum-bone graft taken from the third dorsal compartment region. All patients underwent arthroscopy to document a torn SL ligament. The bone plugs on the graft were fitted into the dorsal scaphoid and lunate, respectively, with the retinaculum periosteal soft tissue intervening sleeve arching between these 2 bones. The SL interval was reduced and pinned for 8 weeks with cast immobilization. The follow-up period averaged 3.6 years (minimum, 24 months). Of the 14 patients with dynamic instability, 12 had no pain and 2 had pain with heavy activity of the wrist. Range of motion (ROM) decreased slightly from preoperative values, and grip strength improved 46%. Thirteen patients were completely satisfied and returned to their former work activities, and 1 returned to modified work activities. Of the 5 patients with static instability, 2 had no pain after surgery, 1 had pain with heavy activity, and 2 had constant pain. ROM in this group decreased moderately in extension/flexion from the preoperative values. Grip strength improved 30% from preoperative values. Satisfaction was rated as complete by 1 patient and partial by 2 patients; 2 patients were dissatisfied. Two patients returned to their former jobs, 2 returned to modified duties, and 1 is on disability. Reconstruction of the SL ligament using a bone-retinaculum-bone autograft is predictable in patients with dynamic instability. Use of this technique with static SL instability is questionable; these patients may require a stronger construct to prevent recurrence of the SL gap.
authors.affiliation: Department of Orthopaedic Surgery, Brown University School of Medicine, Rhode Island Hospital, Providence, USA.
authors.forename: A P
authors.initials: AP
authors.lastname: Weiss
mesh_terms: D000328:Adult; D001182:Arthroscopy; D001858:Bone Nails; D016025:Bone Transplantation / Q000379:methods*; D002348:Carpal Bones / Q000601:surgery*; D005069:Evaluation Studies as Topic; D005205:Fascia / Q000637:transplantation*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000145:classification / Q000503:physiopathology / Q000601:surgery; D008023:Ligaments, Articular / Q000293:injuries / Q000601:surgery*; D012667:Lunate Bone / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D010521:Periosteum / Q000637:transplantation; D016059:Range of Motion, Articular / Q000502:physiology; D012008:Recurrence; D012421:Rupture; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery