title: Association of lesions of the scapholunate interval with arthroscopic grading of scapholunate instability via the geissler classification.
abstract: OBJECTIVE
  To determine whether specific anatomic lesions of the scapholunate supporting structures are associated with the grades of scapholunate instability according to the Geissler classification.
  
  
  METHODS
  Six fresh frozen cadaveric limbs underwent serial arthroscopic sectioning of the scapholunate supporting ligaments. To simulate a progressive scapholunate injury based on the current literature, sectioning occurred as follows: volar scapholunate interosseous ligament (SLIL), membranous SLIL, dorsal SLIL, radioscaphocapitate, long radiolunate, dorsal radiocarpal, dorsal intercarpal, and scaphotrapeziotrapezoid ligaments. We performed arthroscopic examination of the radiocarpal and midcarpal joints after each ligamentous sectioning and recorded the appearance of the scapholunate interval.
  
  
  RESULTS
  There was a progressive increase in Geissler grade with sequential sectioning of the scapholunate supporting ligaments. In all specimens, Geissler grade 2 injury was associated with sectioning of intrinsic ligaments only. Geissler grade 3 injury first appeared with sectioning through the dorsal SLIL and continued through sectioning of the volar extrinsic ligaments. Geissler grade 4 injury did not occur until the dorsal extrinsic ligaments were sectioned. Statistical analysis indicated a linear relationship between ligament sectioned and Geissler grade, with deeper sections associated with a higher Geissler grade.
  
  
  CONCLUSIONS
  In this cadaveric model, arthroscopically determined Geissler grade was associated with specific anatomic lesions of the scapholunate supporting ligaments. Sequential sectioning of the ligaments showed a progressive increase in Geissler grade.
  
  
  CONCLUSIONS
  Knowledge of the association of Geissler grade with pathoanatomy may aid the surgeon in deciding which reconstructive method is best.
authors.affiliation: Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY. Electronic address: lees@hss.edu.
authors.forename: Steve K
authors.initials: SK
authors.lastname: Lee
authors.affiliation: Department of Hand and Upper Extremity Surgery, Hospital for Special Surgery, New York, NY.
authors.forename: Zina
authors.initials: Z
authors.lastname: Model
authors.affiliation: Department of Orthopedic Surgery, Ridgecrest Regional Hospital Center, Ridgecrest, CA.
authors.forename: Healthy
authors.initials: H
authors.lastname: Desai
authors.affiliation: Department of Orthopedic Surgery, MacNeal Hospital, Berwyn, IL.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hsu
authors.affiliation: Department of Orthopedic Surgery, NYU Langone Medical Center, New York, NY.
authors.forename: Nader
authors.initials: N
authors.lastname: Paksima
authors.affiliation: Department of Orthopedic Surgery, University of Calgary, Alberta, Canada.
authors.forename: Gurpreet
authors.initials: G
authors.lastname: Dhaliwal
mesh_terms: D001182:Arthroscopy; D002102:Cadaver; D050824:Carpal Joints / Q000473:pathology*; D006801:Humans; D007593:Joint Instability / Q000145:classification* / Q000473:pathology; D008023:Ligaments, Articular / Q000293:injuries* / Q000473:pathology; D012667:Lunate Bone / Q000473:pathology; D021361:Scaphoid Bone / Q000473:pathology
keywords: Arthroscopy; Geissler; classification; scapholunate; wrist