Radiographic evaluation of the modified Brunelli technique versus a scapholunotriquetral transosseous tenodesis technique for scapholunate dissociation.
OBJECTIVE
To compare reduction of the scapholunate articulation using a transosseous tenodesis through the scaphoid, lunate, and triquetrum (SLT) with the modified Brunelli technique (MBT) in a cadaver model, as measured by scapholunate (SL) angle and diastasis on radiographs.


METHODS
Twelve fresh-frozen cadaveric wrists were radiographically examined in a neutral posture, ulnar deviation, and clenched fist position. The SL angle and diastasis were recorded in each position with the SL ligament intact, after sectioning the ligament and secondary restraints, and after reconstruction by either the MBT (6 wrists) or SLT technique (6 wrists). Wrists were cycled through their maximum flexion and extension arc 100 times to simulate wrist motion after ligament sectioning and reconstruction.


RESULTS
After sectioning and cycling, all wrists demonstrated radiographic evidence of SL diastasis. After ligament reconstruction and cycling, there was no statistically significant difference in diastasis in the MBT reconstructions compared with the SLT reconstructions (3.0 vs 2.4 mm). The SLT group demonstrated better maintenance of the restored SL angle than the MBT reconstructions.


CONCLUSIONS
In this cadaveric model, both MBT and SLT reconstructions restored anatomic parameters in the SL joint, with correction of SL diastasis and SL angle. Future studies to assess the clinical outcomes of SLT tenodesis in patients with chronic SL disruptions are important.


CONCLUSIONS
The SLT tenodesis, with a central biologic tether along the SL axis and dorsal reinforcement, may prove clinically useful.
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA.
Jennifer W
JW
Hsu
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA.
Kathleen M
KM
Kollitz
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA.
Mithulan
M
Jegapragasan
Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, Seattle, WA. Electronic address: jihuang@uw.edu.
Jerry I
JI
Huang
D002102:Cadaver; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D012667:Lunate Bone / Q000601:surgery; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D021361:Scaphoid Bone / Q000601:surgery; D053656:Tenodesis / Q000379:methods*; D051221:Triquetrum Bone / Q000601:surgery; D014955:Wrist Joint / Q000601:surgery*
Brunelli; Scapholunate dissociation; reconstruction; tenodesis