Scapholunate Ligament Injuries: A Review of Current Concepts

Sixty patients who had a displaced intra-articular fracture of the distal end of the radius were managed with manipulative reduction and internal fixation performed under both fluoroscopic and arthroscopic guidance. According to the AO/ASIF classification system, seven fractures were type B1, two were type B2, three were type B3, thirteen were type C1, twelve were type C2, and twenty-three were type C3. Forty-one patients (68 per cent) had soft-tissue injuries of the wrist, including tears of the triangular fibrocartilage complex (twenty-six patients), the scapholunate interosseous ligament (nineteen), and the lunotriquetral interosseous ligament (nine). Thirteen patients had two soft-tissue injuries. Intracarpal soft-tissue injuries were identified most frequently in association with fractures involving the lunate facet of the distal articular surface or the radius.

Different surgical techniques have been proposed to treat traumatic scapholunate instability. Deciding which treatment is best for each individual case is not easy. In this article we report an algorithm of treatment based on a number of prognostic factors that may help in this matter. We also report on the promising results obtained using a new technique, the 3-ligament tenodesis, for the treatment of nonrepairable complete scapholunate ligament rupture, causing a reducible carpal malalignment without secondary osteoarthritis. This technique incorporates features from 3 previously described techniques.

This study assesses the sensitivity and specificity of MRI at 3 T compared with arthroscopy for detection of intrinsic wrist ligament and triangular fibrocartilage complex (TFCC) tears. MR wrist images in 300 consecutive patients underwent consensus review by two radiologists without knowledge of arthroscopy findings. Forty-nine of 300 patients underwent arthroscopy. Thirty-five of these 49 patients also underwent MR arthrography. Scans were assessed for full-thickness scapholunate, lunatotriquetral, or TFCC tears. After consensus review of MR images, arthroscopy results were compared with MR interpretations. Of the 49 patients who underwent arthroscopy, 22 had TFCC tears, 18 had scapholunate tears, and 11 had lunatotriquetral tears (51 total tears at arthroscopy). Nineteen of 22 TFCC tears, 16 of 18 scapholunate tears, and nine of 11 lunatotriquetral tears seen at arthroscopy were seen on MRI. Four patients had both a TFCC tear and a lunatotriquetral ligament tear. One patient had a scapholunate ligament tear and a TFCC tear. There were no false-positive readings on MRI compared with arthroscopy. MR sensitivity for detection of TFCC tears was 86%, for detection of scapholunate tears was 89%, and for detection of lunatotriquetral tears was 82%. MR specificity for detection of tears was 100%. MR arthrography sensitivity for detection of ligament and TFCC tears was 100%. There were three patients in whom contrast media passed between joint spaces without an anatomic abnormality seen. These patients underwent arthroscopy with no tears seen. MRI at 3 T is sensitive and specific for detection of wrist ligament tears. MR arthrography is more sensitive for ligament evaluation but can result in false-positive findings because of microperforations.