Fig. 12.

Surgical procedure of SL ligament reconstruction with FCR tendon strip according to Garcia-Elias. (a) Through a splitting capsulotomy the SL joint is exposed and the SL ligament is absent. (b) Scaphoid bone tunnel is prepared using a drill starting from the proximal dorsal side of it. (c) X-ray images show the position of the K-wires in lateral and AP views. (d) FCR tendon strip is passed through the tunnel from the palmar to the dorsal side. (e) The tendon strip is prepositioned into the RT ligament, a limited fossa is created in the position of the previously existing SL ligament to the dorsal side of the lunate, and a suture anchor is positioned. (f) The tendon strip is pulled and sutured at the lunate fossa and to itself by separated sutures. SC and SL joints are temporary fixed by two K-wires. (g) Splitting capsule is turned to cover the joint, and suture is used to fixed it to the tendon strip. (h) Intraoperative fluoroscopy showing the correct position of both the K-wires and the suture anchor with anatomical closure of the SL joint. (i) Clinical result at follow-up: good flexion-extension of the wrist. (l) X-ray images at the follow-up that show the recurrence of SL limited dissociation (completely asymptomatic).