title: Arthroscopic debridement and closed pinning for chronic dynamic scapholunate instability.
abstract: OBJECTIVE
  For chronic dynamic scapholunate (SL) instability (>3 months after injury) open procedures (capsulodesis, limited intercarpal fusions, tenodesis, SL ligament reconstruction) have become popular in recent years but their long-term results have been suboptimal. We evaluated retrospectively the results of aggressive arthroscopic debridement of the SL ligament to bleeding bone in an effort to induce scar formation and closed pinning of the SL joint in patients unwilling to have an open procedure.
  
  
  METHODS
  Eleven patients (mean age, 37 y) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with dynamic SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a Geissler grade III or IV SL tear) and treated. Range of motion, grip strength, radiographic measurements, and the Mayo wrist score were used to evaluate the results.
  
  
  RESULTS
  The mean follow-up period was 33 months (range, 12-76 mo). Three patients had subsequent surgery 9 to 11 months after the procedure. Subsequent surgeries included a dorsal capsulodesis, a four-corner fusion, and a wrist arthrodesis. Of the 8 remaining patients there were 2 excellent, 4 good, 1 fair, and 1 poor result based on the Mayo wrist score. In these patients the mean range of motion was 65 degrees of extension to 59 degrees of flexion and the mean grip strength was 82% of the uninjured contralateral extremity. Although persistent radiographic SL gapping in grip views was noted in all 8 patients none progressed to static instability or dorsal intercalated segment instability.
  
  
  CONCLUSIONS
  The results of this technique are suboptimal; however, it may be an option for patients unwilling to have more than an arthroscopic procedure or those requiring maintenance of wrist motion, provided they understand the risks and benefits of this approach.
  
  
  METHODS
  Therapeutic, Level IV.
authors.affiliation: Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
authors.forename: Nickolaos A
authors.initials: NA
authors.lastname: Darlis
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kaufmann
authors.forename: Filippos
authors.initials: F
authors.lastname: Giannoulis
authors.forename: Dean G
authors.initials: DG
authors.lastname: Sotereanos
mesh_terms: D000328:Adult; D001182:Arthroscopy; D001858:Bone Nails; D050824:Carpal Joints / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D002908:Chronic Disease; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D012667:Lunate Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology; D012189:Retrospective Studies; D021361:Scaphoid Bone / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*