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KMID : 1143020200250020108
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Archives of Hand and Microsurgery
2020 Volume.25 No. 2 p.108 ~ p.117
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Results of Arthroscopically Assisted Volar and Dorsal Scapholunate Ligament Reconstruction Using Flexor Carpi Radialis: Modified Arthroscopic Corella Technique
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Park Yong-Cheol
Kim Myung-Sun
Lee Young-Keun
Seo Chang-Young
Shin Sang-Gyoo
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Abstract
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Purpose: We evaluated results of arthroscopically assisted volar and dorsal scapholunate (SL) ligament reconstruction using flexor carpi radialis (FCR).
Methods: We reviewed 31 cases who had been operated from August 2015 to June 2018. Two cases were excluded and 4 cases lost contact. Twenty-five wrists were included. The average follow-up duration was 25.3 months. Diagnostic arthroscopy was performed to evaluate European Wrist Arthroscopy Society (EWAS) stage of SL instability and the reparability of SL ligament. The SL reconstruction was performed for the cases which showed EWAS stage IIIC, IV having gap over 3 mm and irreparable SL ligament. The interval between the diagnosis and operation was 5.9 days in average. We modified the arthroscopic Corella technique by repairing the graft tendon to FCR.
Results: All SL joints were stabilized to EWAS stage I arthroscopically after reconstruction. Disabilities of Arm, Shoulder and Hand (DASH) score changed from 32.7 to 9.7. Grip power changed from 74.1% to 93.3%. Modified Mayo wrist score was 83.8. Preoperative SL angle was 53.8°, postoperative 49.6° and the last was 51.2°. The improvement between preoperative and last follow-up SL angle was statistically significant (p<0.05). The SL angle from operation to last follow-up has increased by 1.67° (39.8%, p<0.01). Twelve cases showed SL gap over 2 mm in clenched fist view before operation, but no case at follow-up.
Conclusion: Volar and dorsal SL reconstruction using FCR should provide more stability and strength than only dorsal SL reconstruction. Arthroscopic technique has the merit that it causes minimal damage to extrinsic carpal ligaments and posterior interosseous nerve and can provide rapid recovery.
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KEYWORD
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Scapholunate, Reconstruction, Arthroscopic, Corella technique
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