Table 3.

Pearls and Pitfalls

The ideal candidates are patients with a partial or complete injury, either acute or early subacute (<3-4 wk).

The arthroscopic portals we use are the 3-4, 6R, MCU, and MCR portals.

From the 6R portal, we have the best view of the proximal and dorsal part of the SLL.

The cleaning of the fibers and scar material and the cruentation of the insertion of the SLL are important to stimulate healing.

It is mandatory that the tissue of the injured ligament is of good quality, allowing its repair. Non-acute cases may have friable tissue.

The 3-4 portal is used as the working portal, introducing the anchor and passing the sutures through the SLL.

In a small wrist, it is sometimes necessary to use the 4-5 portal as an accessory working portal.

Sometimes, to improve the scapholunate reduction, we need to use the Kirschner wires as a joystick, and sometimes one Kirschner wire between the radius and lunate is needed to maintain the radiolunate alignment.

We use a knot pusher, performing a sliding knot to reattach the ligament. The knot must not be cut.

To perform the dorsal arthroscopic capsulodesis, we pass one of the sutures through the SLL to the midcarpal joint, and we recover it through the MCR portal and through the subcutaneous space to the 3-4 portal. Then, we have to knot the sutures again to complete the dorsal plication.

When we have a complete SLL tear associated with a fracture, we must finish the intra-articular procedures first. Once we perform the dorsal capsulodesis, the 3-4 portal must not be used anymore because the dorsal plication can be damaged.

MCR, midcarpal radial; MCU, midcarpal ulnar; SLL, scapholunate ligament.