Scapholunate ligament reconstruction using the palmaris longus tendon and suture anchor fixation in chronic scapholunate instability

• Published in: Indian journal of orthopaedics Vol. 50; no. 6; pp. 616 - 621
• Main Authors: Gandhi, Maulik Jagdish, Knight, Timothy Paul, Ratcliffe, Peter John
• Format: Journal Article
• Language: English
• Published: New Delhi Springer India 01.11.2016; Wolters Kluwer India Pvt. Ltd; Medknow Publications and Media Pvt. Ltd; Medknow Publications & Media Pvt. Ltd; Medknow Publications & Media Pvt Ltd
• Subjects: Conservative Orthopedics; Medicine & Public Health; Original; Original Article; Orthopedic surgery; Orthopedics; Plastic surgery; Postwar reconstruction; Surgical Orthopedics; carpal bones; scapholunate; palmaris longus; Wrist joint; lunate bone; Anchor fixation; reconstruction; chronic scapholunate instability; joint instability; ligaments; chronic scapholunate instability MeSH terms: Wrist joint
• ISSN: 0019-5413; 1998-3727
• DOI: 10.4103/0019-5413.193484

Background Multiple reconstruction techniques have been described in the management of chronic scapholunate (SL) instability, either based on the capsulodesis or tenodesis principle. It is uncertain which surgical method produces the best patient outcomes. We describe results of a technique using palmaris longus (PL) tendon for surgical reconstruction of the SL ligament and provide functional outcomes scores. Materials and Methods We surgically reconstructed the SL ligament using a PL tendon graft secured with Mitek® bone anchors. Surgical technique with photographs is provided in the main text. Functional outcomes were measured using the disabilities of the arm, shoulder, and hand and Mayo wrist scores. Patient satisfaction was assessed using a simple measure. Results Eleven patients attended mid-term followup (mean 45.8 months post-surgery) and had functional outcomes and satisfaction of this procedure that compared favorably to case series that used tenodesis for chronic SL ligament injuries. Almost all patients ( n = 10) were able to return to regular employment. The majority of patients ( n = 10) were satisfied with their primary reconstruction procedure. Conclusion This technique avoids the use of drill holes to weave tendon through bone, uses an easy to access graft, and exploits the superior pullout strength of anchors while offering satisfactory functional outcomes that are comparable to alternative tenodesis techniques.