title: Scapholunate ligament reconstruction using a periosteal flap of the iliac crest: a biomechanical study.
abstract: BACKGROUND
  Advances continue to improve direct reconstruction of the dorsal scapholunate (SL) ligament, which is the strongest part of the entire SL ligament and is known as the turning point between the scaphoid and lunate. This study was designed to compare the biomechanical properties of the dorsal SL ligament with those of a periosteal flap of the iliac crest, which is a new graft candidate for dorsal SL reconstruction.
  
  
  METHODS
  A bone-ligament-bone complex was harvested for biomechanical testing from the iliac crest and the dorsal SL complex. Ten specimens could be prepared in each group. After potting the bone blocks in methylmethacrylate for stable fixation, the specimens were tested, using a servohydraulic testing system, at a rate of 10 mm/min.
  
  
  RESULTS
  Failure displacement, failure force, failure stress, energy to failure, and stiffness were assessed for both groups. Eight specimens in each group were tested successfully. In the ligament group, six specimens failed at the ligament level, whereas two failed at the insertion of the scaphoid. In the periosteum group, all eight specimens failed at the ligament level. The failure force of the dorsal SL ligament averaged 171.8 N, failure stress was 10.3 N/mm2, and failure displacement amounted to 2.9 mm. Energy to failure was 269.1 N-mm, and stiffness averaged 77.2 N/mm. Failure force of the periosteal flap amounted to 144.3 N, failure stress was 9.9 N/mm2, failure displacement was 3.0 mm, and energy to failure was 217.9 N-mm. Stiffness of the periosteal flap measured 60.5 N/mm. Comparison of the dorsal SL ligament and the periosteal flap of the iliac crest revealed no significant biomechanical differences.
  
  
  CONCLUSIONS
  Therefore, the biomechanical properties of the periosteal flap recommend its use for reconstruction of the dorsal SL ligament.
authors.affiliation: Department of Trauma Surgery, University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria. martin.lutz@uklibk.ac.at
authors.forename: M
authors.initials: M
authors.lastname: Lutz
authors.forename: C
authors.initials: C
authors.lastname: Haid
authors.forename: M
authors.initials: M
authors.lastname: Steinlechner
authors.forename: A
authors.initials: A
authors.lastname: Kathrein
authors.forename: R
authors.initials: R
authors.lastname: Arora
authors.forename: D
authors.initials: D
authors.lastname: Fritz
authors.forename: M
authors.initials: M
authors.lastname: Gabl
authors.forename: S
authors.initials: S
authors.lastname: Pechlaner
mesh_terms: D001696:Biomechanical Phenomena; D016025:Bone Transplantation; D002102:Cadaver; D006801:Humans; D007082:Ileum / Q000601:surgery; D008023:Ligaments, Articular / Q000503:physiopathology / Q000601:surgery*; D012667:Lunate Bone / Q000503:physiopathology / Q000601:surgery*; D013314:Stress, Mechanical; D016896:Treatment Outcome; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery