Long-term results of dorsal intercarpal ligament capsulodesis for the treatment of chronic scapholunate instability

J Bone Joint Surg Br. 2012 Dec;94(12):1660-5. doi: 10.1302/0301-620X.94B12.30007.

Abstract

The purpose of this study was to assess the clinical and radiological outcomes of dorsal intercarpal ligament capsulodesis for the treatment of static scapholunate instability at a minimum follow-up of four years. A total of 59 patients who underwent capsulodesis for this condition were included in a retrospective analysis after a mean of 8.25 years (4.3 to 12). A total of eight patients underwent a salvage procedure at a mean of 2.33 years (0.67 to 7.6) and were excluded. The mean range of extension/flexion was 88° (15° to 135°) and of ulnar/radial deviation was 38° (0° to 75°) at final follow-up. The mean Disabilities of the Arm Shoulder and Hand (DASH) score and Mayo wrist scores were 28 (0 to 85) and 61 (0 to 90), respectively. After significant improvement immediately post-operatively (p < 0.001 and p = 0.001, respectively), the mean scapholunate and radiolunate angles deteriorated to 70° (40° to 90°) and 8° (-15° to 25°), respectively, at final follow-up, which were not significantly different from their pre-operative values (p = 0.6 and p = 0.4, respectively). The mean carpal height index decreased significantly from 1.53 (1.38 to 1.65) to 1.48 (1.29 to 1.65) indicating progressive carpal collapse (p < 0.001); 40 patients (78%) had radiological evidence of degenerative arthritis. Capsulodesis did not maintain carpal reduction over time. Although the consequent ongoing scapholunate instability resulted in early arthritic degeneration, most patients had acceptable long-term function of the wrist.

MeSH terms

  • Adolescent
  • Adult
  • Carpal Bones / diagnostic imaging
  • Carpal Bones / surgery*
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Humans
  • Joint Capsule / diagnostic imaging
  • Joint Capsule / surgery*
  • Joint Instability / surgery*
  • Ligaments, Articular / surgery*
  • Lunate Bone / diagnostic imaging
  • Lunate Bone / surgery*
  • Male
  • Middle Aged
  • Radiography
  • Range of Motion, Articular
  • Retrospective Studies
  • Scaphoid Bone / diagnostic imaging
  • Scaphoid Bone / surgery*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Wrist Joint / diagnostic imaging
  • Wrist Joint / surgery*
  • Young Adult