The Biomechanical Effects of Augmentation With Flat Braided Suture on Dorsal Intercarpal Ligament Capsulodesis for Scapholunate Instability

doi:10.1016/j.jhsa.2020.10.032

The Journal of Hand Surgery

Volume 46, Issue 6, June 2021, Pages 517.e1-517.e9

https://doi.org/10.1016/j.jhsa.2020.10.032 Get rights and content

Purpose

Selecting treatment for scapholunate (SL) instability is notoriously difficult. Many methods of reconstruction have been described, but no procedure demonstrates clear superiority. New methods proposed use internal bracing (IB) with suture anchors and flat braided suture (FBS), alone or as an augmentation with tendon autograft for SL ligament injuries. Our goal was to use computed tomography (CT) to analyze alignment of the SL joint after 3 different modes of fixation of SL instability: after reconstruction with IB incorporating either tendon autograft or the dorsal intercarpal ligament (DICL), or DICL capsulodesis without FBS.

Methods

Ten fresh-frozen, matched-pair, forearm-to-hand specimens were used. Serial sectioning of the SL stabilizing ligaments was performed and the SL interval was measured with CT. We reconstructed the SL ligament with DICL capsulodesis alone (DICL) or with IB augmented with either tendon autograft (IB plus T) or DICL (DICL plus IB). The SL interval was measured with CT. Specimens underwent 500 weighted cycles on a jig and were reimaged. Differences in SL interval after repair and cycling were compared.

Results

Dorsal intercarpal ligament capsulodesis augmented with IB best maintained the SL interval before and after cycling. Dorsal intercarpal ligament capsulodesis alone was inferior to DICL plus IB and IB plus T both before and after cycling.

Conclusions

Dorsal intercarpal ligament capsulodesis augmented with IB appears to maintain better SL joint reduction than IB with tendon autograft.

Clinical relevance

This work serves as a necessary step for further study of the biomechanical strength and clinical application of FBS technology in the reconstruction of SL instability. Flat braided suture augmentation of DICL capsulodesis may provide another option to consider for reconstruction of SL instability.

Section snippets

Materials and Methods

We obtained 10 fresh-frozen, matched-pair, proximal forearm-to-hand specimens from the University of California, Davis Anatomical Materials Program (mean age, 77 years; range, 66–87 years). This was a sample of convenience. Radiographs of the specimens confirmed no evidence of preexisting arthritis, injury, or surgical interventions. Cadaveric arms were thawed overnight at 4°C before specimen dissection.

Results

Table 1 lists individual specimen results. The expected increase in SL interval from native at stage 5 was observed, with a subsequent decrease in interval after repair.

The following results are displayed in Table 2. A positive result indicates a reduced interval between the first listed technique and the comparison technique. The DICL and IB provided better reduction of the SL interval than IB and T by 0.95 ± 0.75 mm (P ≤ .05; 95% CI, 0.02–1.88) before cycling and 0.90 ± 0.71 mm (P ≤ .05; 95%

Discussion

Dorsal intercarpal ligament capsulodesis is an accepted option for surgical treatment of SL instability because it limits abnormal scaphoid flexion.³⁴ However, rates of successful reconstruction with capsulodesis have varied widely, likely owing to heterogeneous populations, timing of presentation and surgery, surgical technique, quality of residual ligament, and extent of degeneration.¹¹^,35, 36, 37 Radiographic loss of anatomic reduction is documented in multiple studies.¹^,¹¹^,³⁵ Soft tissue

Acknowledgments

Conflicts of Interest and Source of Funding: Sequoia Surgical Inc–Arthrex (Sacramento, CA) provided materials for the cadaveric surgeries and funding for supplies. Cadaveric specimens for photography of surgical technique were made available from Sequoia Surgical Inc–Arthrex. The authors received no reimbursement for the study, or any expenses related to publication or presentation. We thank Sandra Taylor, PhD from the UC Davis Clinical and Translation Research Center for assistance with

References (63)

V.K. Gajendran et al.
Long-term outcomes of dorsal intercarpal ligament capsulodesis for chronic scapholunate dissociation
J Hand Surg Am
(2007)
S.F. Viegas et al.
The dorsal ligaments of the wrist: anatomy, mechanical properties, and function
J Hand Surg Am
(1999)
A. Boabighi et al.
The distal ligamentous complex of the scaphoid and the scapho-lunate ligament: an anatomic, histological and biomechanical study
J Hand Surg Eur Vol
(1993)
J.L. Goldner
Treatment of carpal instability without joint fusion—current assessment
J Hand Surg Am
(1982)
D.J. Conyers
Scapholunate interosseous reconstruction and imbrication of palmar ligaments
J Hand Surg Am
(1990)
J.F. Chabas et al.
Results of the modified Brunelli tenodesis for treatment of scapholunate instability: a retrospective study of 19 patients
J Hand Surg Am
(2008)
G.A. Brunelli et al.
A new surgical technique for carpal instability with scapho-lunar dislocation. (Eleven cases) [in French]
Ann Chir Main Memb Super
(1995)
A.C. Links et al.
Scapholunate interosseous ligament reconstruction: results with a modified Brunelli technique versus four-bone weave
J Hand Surg Am
(2008)
R.M. Szabo
Scapholunate ligament repair with capsulodesis reinforcement
J Hand Surg Am
(2008)
J. Pomerance
Outcome after repair of the scapholunate interosseous ligament and dorsal capsulodesis for dynamic scapholunate instability due to trauma
J Hand Surg Am
(2006)

G. Blatt

Capsulodesis in reconstructive hand surgery: dorsal capsulodesis for the unstable scaphoid and volar capsulodesis following excision of the distal ulna

Hand Clin

(1987)

R.M. Szabo et al.

Dorsal intercarpal ligament capsulodesis for chronic, static scapholunate dissociation: clinical results

J Hand Surg Am

(2002)

A. Gray et al.

Midterm outcome of bone-ligament-bone graft and dorsal capsulodesis for chronic scapholunate instability

J Hand Surg Am

(2015)

A.P. Weiss

Scapholunate ligament reconstruction using a bone-retinaculum-bone autograft

J Hand Surg Am

(1998)

I.J. Park et al.

Internal bracing augmentation for scapholunate interosseous ligament repair: a cadaveric biomechanical study

J Hand Surg Am

(2020)

S.S. Shin et al.

Suture tape augmentation of the thumb ulnar collateral ligament repair: a biomechanical study

J Hand Surg Am

(2018)

M.C. Kindya et al.

Knotless suture anchor with suture tape quadriceps tendon repair is biomechanically superior to transosseous and traditional suture anchor-based repairs in a cadaveric model

Arthroscopy

(2017)

C.H.W. Heusdens et al.

Anterolateral ligament repair with suture tape augmentation

Arthrosc Tech

(2018)

R.J. Gnandt et al.

High-tensile strength tape versus high-tensile strength suture: a biomechanical study

Arthroscopy

(2016)

L.J. Bisson et al.

A biomechanical comparison of the pullout strength of No. 2 FiberWire suture and 2-mm FiberWire tape in bovine rotator cuff tendons

Arthroscopy

(2010)

H. Mitsuyasu et al.

The role of the dorsal intercarpal ligament in dynamic and static scapholunate instability

J Hand Surg Am

(2004)

A. Kitay et al.

Scapholunate instability: current concepts in diagnosis and management

J Hand Surg Am

(2012)

S.L. Moran et al.

Capsulodesis for the treatment of chronic scapholunate instability

J Hand Surg Am

(2005)

C.J. Lavernia et al.

Treatment of scapholunate dissociation by ligamentous repair and capsulodesis

J Hand Surg Am

(1992)

P.C. Zarkadas et al.

A survey of the surgical management of acute and chronic scapholunate instability

J Hand Surg Am

(2004)

R.R. Slater et al.

Dorsal intercarpal ligament capsulodesis for scapholunate dissociation: biomechanical analysis in a cadaver model

J Hand Surg Am

(1999)

D.J. Leishman et al.

Suture tape with broad full-width core versus traditional round suture with round core: a mechanical comparison

Arthroscopy

(2019)

N.A. Patel et al.

Kinematics of thumb ulnar collateral ligament repair with suture tape augmentation

J Hand Surg Am

(2020)

S.L. Moran et al.

Outcomes of dorsal capsulodesis and tenodesis for treatment of scapholunate instability

J Hand Surg Am

(2006)

C.B. Frank et al.

Molecular biology and biomechanics of normal and healing ligaments—a review

Osteoarthritis Cartilage

(1999)

H. Tsukada et al.

The actual tendon-bone interface strength in a rabbit model

Arthroscopy

(2010)

Cited by (3)

Preliminary Outcomes of Scapholunate Ligament Augmentation with Internal Brace Technique
2024, Journal of Hand Surgery Global Online
Injury to the scapholunate (SL) interosseous ligament (SLIL) is a common cause of carpal instability. Internal brace augmentation has been used in various ligament repair procedures; however, further investigation of its outcomes in hand surgery is needed. This study aimed to examine outcomes for patients who underwent SLIL repair with internal brace augmentation.
Patients who underwent SLIL repair with the internal brace technique and had at least 1 year of follow-up were contacted. Available patients returned for an in-person evaluation with new radiographs and physical examination. If patients could not be contacted but had x-rays and physical examinations performed at greater than 1 year after surgery, these data were collected from their medical records. Participating patients completed the QuickDASH and Patient-Rated Wrist Evaluation surveys and rated their satisfaction with the surgery. Outcomes assessed included wrist range of motion, grip strength, scaphoid shift test, SL gap, SL angle, and radiographic evidence of radiocarpal arthritis.
We collected outcomes for 14 SLIL repairs among 13 patients (12 male). Mean length of the follow-up was 41 months (n = 14, 17–64). Mean QuickDASH and Patient-Rated Wrist Evaluation scores were 6.1 (0–43.2) and 9.6 (0–65), respectively. Radiographic measurements remained stable from immediate to latest follow-up, and no radiocarpal arthritic changes were noted. However, SL gap decreased from a mean of 5.33 mm (3.4–6.7) before surgery to 3.34 mm (2–4.6) at the latest follow-up, and SL angle decreased from a mean of 79.5° (67°–97°) before surgery to 67.3° (51°–85°) at the latest follow-up. All scaphoid shift tests were stable.
Therefore, SL internal brace augmentation has favorable short-term results with improvements in pain, function, satisfaction, and carpal alignment at greater than 1 year postoperatively. This technique can be an effective option for the management of SL instability in the short term.
Therapeutic IV.
Scapholunate Instability: Diagnosis and Management – Classification and Treatment Considerations – Part 2
2023, Journal of Hand Surgery
Intervention for scapholunate instability is aimed at halting the degenerative process by restoring ligament integrity and normalizing carpal kinematics. Part 1 of this Current Concepts article reviewed the anatomy, kinematics, and biomechanical properties of the scapholunate ligament as well as its critical stabilizers. In this section, we provide a foundation for understanding the spectrum of scapholunate ligament instability and incorporate meaningful new anatomical insights that influence treatment considerations. These updates clarify the importance of the critical stabilizers of the scapholunate interval, ligament-specific considerations in scapholunate ligament reconstruction, and the risks of ligament disinsertion when surgically exposing the dorsal wrist. We propose a ligament-based treatment algorithm based on the stage of injury, degree and nature of ligament damage, and presence of arthritic changes.
Treatment of chronic scapholunate instability according to the functional demand of the wrist
2023, Hand Surgery and Rehabilitation
Scapholunate instability is the most common form of carpal instability. Complete scapholunate ligamentous complex failure can lead to pain, reduced functional performance, and scapholunate advanced collapse if untreated. The goal of surgery for chronic scapholunate instability (diagnosed later than 6 weeks) before onset of osteoarthritis is to correct the scapholunate instability in order to reduce pain while limiting loss of motion and protecting against osteoarthritis-related collapse in the long-term. Because many ligament reconstruction techniques have been described and not every patient is a candidate for a demanding procedure, we addressed the question of what is the best adapted treatment for each stage of chronic scapholunate instability? This article reviews the anatomy and biomechanical properties of the scapholunate complex and the current diagnostic tools in scapholunate instability. A treatment algorithm based on instability stage and the patient’s functional demand is proposed.
III.
L’instabilité scapho-lunaire est la plus fréquente des instabilités du carpe. La déficience complète du complexe ligamentaire scapho-lunaire peut entrainer douleur, impotence fonctionnelle et arthrose par collapsus du carpe en l’absence de traitement. Le but d’une intervention pour instabilité scapho-lunaire chronique (vue à plus de 6 semaines) avant l’apparition d’arthrose est de corriger l’instabilité afin de diminuer la douleur sans perdre trop en mobilité et d’arrêter ainsi le processus dégénératif arthrosique à long terme. Parce que de nombreuses techniques de reconstruction du ligament scapho-lunaire ont été décrites et parce que chaque patient n’est pas forcément candidat à une chirurgie lourde, nous avons essayé de répondre à la question: quel est le traitement le plus adapté au patient à chaque stade de l’instabilité scapho-lunaire chronique? Ce travail passe en revue l’anatomie du complexe scapho-lunaire, ses propriétés biomécaniques et les moyens de diagnostic actuels de dépistage l’instabilité scapho-lunaire. Un algorithme de traitement, basé sur le degré d’instabilité et sur la demande fonctionnelle du patient, est proposé.
III.

: No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

View full text

Scientific ArticleThe Biomechanical Effects of Augmentation With Flat Braided Suture on Dorsal Intercarpal Ligament Capsulodesis for Scapholunate Instability

Purpose

Methods

Results

Conclusions

Clinical relevance

Section snippets

Materials and Methods

Results

Discussion

Acknowledgments

J Hand Surg Am

J Hand Surg Am

J Hand Surg Eur Vol

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

Ann Chir Main Memb Super

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

Hand Clin

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

Arthroscopy

Arthrosc Tech

Arthroscopy

Arthroscopy

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

J Hand Surg Am

Arthroscopy

J Hand Surg Am

J Hand Surg Am

Osteoarthritis Cartilage

Arthroscopy

Scientific Article
The Biomechanical Effects of Augmentation With Flat Braided Suture on Dorsal Intercarpal Ligament Capsulodesis for Scapholunate Instability