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Journal of Wrist Surgery logoLink to Journal of Wrist Surgery
. 2020 May 20;9(4):328–337. doi: 10.1055/s-0040-1710502

Arthroscopic Reinsertion of Acute Injuries of the Scapholunate Ligament Technique and Results

Vicente Carratalá 1,✉, Francisco Javier Lucas 1, Ignacio Miranda 2, Alfonso Prada 3, Eva Guisasola 1, Francisco J Miranda 4
PMCID: PMC7395848  PMID: 32760612

Abstract

Objective  To describe a technique for treating acute injuries of the scapholunate ligament (SLL) by performing an arthroscopic reinsertion of the SLL and dorsal capsulodesis and to present the results obtained.

Methods  The study deals with an analytical, prospective clinical study that included 19 consecutive patients with acute injury of the SLL. The range of joint motion, grip strength, pain according to the visual analog scale, functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were studied preoperatively and 6 and 12 months postoperatively. The complications and necessary reinterventions were recorded.

Results  Nineteen patients with acute injury of the SLL were studied; mean age was 44 ± 2 years, 74% males, 58% complete rupture, and 42% partial rupture, treated with the above-mentioned technique. Thirty-seven percent also had a distal radius fracture and there was one case of perilunate dislocation. Improvement in pain, grip strength, joint balance, and functionality was observed 6 and 12 months postoperatively, with 79% of the cases with good or excellent results

Conclusion  The arthroscopic reinsertion and dorsal capsular reinforcement of the SLL, allow a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to aggressive interventions on the soft tissues that are inherent to the open dorsal approach.

Keywords: acute injury of the scapholunate ligament, scapholunate ligament complex, arthroscopy, dorsal capsular reinforcement

Scapholunate ligament (SLL) injury is the lesion that most commonly occurs in the intrinsic ligaments of the carpus, generally as a result of falling on the outstretched hand. 1

The term scapholunate (SL) dissociation refers to injuries that go from a partial tear of the SLL to a complete injury of this ligament, which can also include injury to the secondary stabilizers, 2 giving rise to rotatory subluxation of the scaphoid bone, dorsal-intercalated segment instability and, finally, osteoarthritis of the wrist, known as scapholunate advanced collapse (SLAC), when not treated appropriately. 3

The different imaging tests used for diagnosing SL dissociation, including magnetic resonance imaging and arthrography, have a high percentage of false negatives. 4 5 The gold standard for diagnosing SL injuries is wrist arthroscopy, which also allows for in situ treatment of the lesion. 6

The SLL does not function on its own; it is part of the SLL complex formed by an intrinsic component, which is the actual SLL with its dorsal, palmar, and proximal aspects, 7 and an extrinsic component, comprising the secondary stabilizers, which include the dorsal intercarpal ligaments (DIL), dorsal radiocarpal ligaments, and the palmar radioscaphocapitate, long radiolunate, and short radiolunate ligaments. 2

The dorsal aspect of the SLL is the thickest and most resistant and plays the most important role in SL stability, mainly due to its attachment to the dorsal capsule. 8 The dorsal capsuloligamentous scapholunate septum (DCSS) is also a part of the SL complex, joining the ligament to the dorsal capsule and the DIL, and it has been demonstrated that it plays an important role in stabilizing it. 9

Both the dorsal and the palmar aspects of the SLL are vascularized structures: the dorsal aspect is mainly supplied through the dorsal capsuloligamentous septum and the palmar aspect is supplied through the radioscapholunate ligament (ligament of Testut). 10 The healing potential of SL injuries is limited, despite vascularization in these areas, and treatment during the acute phase of the injury is crucial. 5

Several arthroscopic or arthroscopy-assisted treatments have been described for SLL injuries, but only a few are aimed at primary repair of the ligament, especially its dorsal aspect, which, as previously indicated, is the segment that is most relevant for SL stability. 11

Arthroscopy-assisted reduction and temporary fixation with Kirschner wires (KW) is indicated for acute, Geissler II-III injuries. Fixation should be maintained for a minimum of 6 to 8 weeks. 6 12

This technique has given varying results. The best results were observed in a series of patients with Geissler grade II-III acute or subacute injuries and incomplete SL tears. 13 The results of complete SLL injuries and those of patients who were not treated during the acute phase were considerably worse, with satisfactory results being achieved only in 55% of the cases. 14

Garcia-Elias et al 2 published a series of prognostic factors for grading and directing treatment of SL injuries. Acute injuries of the SLL are integrated in the three first stages, can be one the first three, not only one; the extension of the injury and the possibility of repairing the ligament are key factors for directing treatment.

In cases of an acute complete rupture of the SLL (Geissler Grade IV) with a repairable dorsal ligament, the recommended conventional treatment is direct repair using an open dorsal approach, with direct suture, transosseous suture, or reinsertion with bone anchors, sometimes in combination with capsular reinforcement or dorsal capsulodesis. 15 16 This repair can be performed in combination with temporary fixation with KW or with fixation placing a screw between the scaphoid and semilunar bones, thereby allowing for earlier recovery of movement. 6 Satisfactory results have been published with open SLL repair techniques 15 16 17 but they are associated with significant wrist stiffness.

In addition to damaging soft tissues and increasing fibrosis and joint rigidity, the dorsal wrist approach used for treating SL injuries almost always injures the posterior interosseous nerve (PIN), which is involved in the proprioception of the SLL 18 and can be fundamental for dynamic stability and functional recovery. Moreover, during the approach and dorsal capsulotomy, there is also a significant aggression on the vascular supply to the SLL, which impairs its healing capacity. Finally, the secondary dorsal stabilizers are also affected by this surgical approach. 19

There are reports of dorsal and palmar arthroscopic capsuloligamentous suturing techniques, 20 21 but none of these cases deal with acute primary repair of the injured/detached ligament, and therefore do not reproduce the repair like it could be done in open surgery.

The objective of this study was to describe an all arthroscopic technique for treating acute injuries of the SLL performing a reinsertion of the SLL with dorsal capsulodesis and to present the results obtained.

Materials and Methods

A prospective study was conducted including 19 consecutive patients with acute SLL injury who underwent arthroscopic suturing of the SLL. The study protocol was approved by the Ethics Committee of the Hospital Center.

Prospective follow-up of the patients was performed with systematic collection of data preoperatively at 6 and 12 months. Minimum follow-up was 12 months from surgery (range: 12–38 months). It was not possible to collect preoperative data for patients with a distal radius fracture or with fracture dislocation.

During follow-up, the range of joint motion, grip strength, pain according to the visual analog scale (VAS), functional outcomes according to the Mayo Wrist Score (MWS), and the QuickDASH Score were measured, and the complications and necessary reinterventions were recorded.

Nineteen patients were included: 11 patients with an isolated SLL injury, seven with associated distal radius fracture, and one patient with associated perilunate dislocation. All patients had simple X-rays of the wrist and some were submitted to a magnetic resonance scan to complete the study and CT scan in cases of distal radius fracture. Arthroscopy was performed in all cases to confirm the diagnosis and treat the injury. In the seven cases that had an associated distal radius fracture, open reduction and osteosynthesis were performed first, followed by wrist arthroscopy.

Degenerative changes were studied using the simple X-rays to rule out any possible old lesions. Patients showing any kind of degenerative change or with nonacute lesions of the SLL were excluded.

Arthroscopic Suturing of the SLL

Ideal candidates are those with a partial or complete, acute or subacute injury (up to 2–4 weeks from the injury), with competent secondary stabilizers, and with no chondral involvement, i.e., predynamic SL instability according to the García Elías classification, 2 in which the SLL still preserves some potential for healing and the state of the tissue permits direct repair. This technique can be performed on acute isolated injuries of the SLL and those associated with distal radius fractures. 22 This technique is not indicated for chronic lesions or nonreducible instability.

The arthroscopic portals used for this technique are: 3–4, 6R, midcarpal ulnar (MCU), and midcarpal radial (MCR; Fig. 1 ).

Fig. 1.

Fig. 1

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Arthroscopic portals: 3 to 4, 6R, midcarpal ulnar (MCU) and midcarpal radial (MCR).

1. Insertion of the anchor and ligamentous suture

With the scope in the 6R portal, directing vision toward the dorsal aspect of the carpus, using the 3–4 portal as a working portal, a 2.2-mm Micro Corkscrew suture anchor (Arthrex, Naples, FL) is introduced into the dorsal and proximal edge of the scaphoid or lunate bone, depending on where the SLL has been detached ( Fig. 2 ) until it is completely buried in the articular surface. Through the 3–4 portal both bones can be accessed. This anchor needs a predrill before its application that is done through the same 3–4 portal.

Fig. 2.

Fig. 2

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( A, B ) View from the 6R portal. Introduce a 2.2-mm Micro Corkscrew suture anchor (Arthrex, Naples, FL) in the dorsal and proximal margins of the scaphoid or lunate bone, depending on where the SLL has detached. ( C, D ) Using a TFCC SutureLasso of 70° (Arthrex, Naples, FL) from 3 to 4, cross the remains of the SLL from dorsal to proximal, recovering the nitinol loop through the same portal. L, lunate; R, radius; SC, scaphoid; SLL, scapholunate ligament; TFCC, triangular fibrocartilage complex.

The anchor sutures ends are left in the 3–4 portal, and, using the TFCC SutureLasso 70° (Arthrex, Naples, FL) from the 3–4 portal, we cross the remains of the SLL from dorsal to proximal, recovering the nitinol loop through the same portal ( Fig. 2 ). Using the loop, one of the sutures' ends of the implant is passed through the detached edge of the ligament and is pulled out again through the 3–4 portal ( Fig. 3 ). Subsequently, using a knot pusher, we tie both sutures in a sliding knot over the implant, leaving a simple stitch through the SLL with the sutures tied and uncut ( Fig. 3 ).

Fig. 3.

Fig. 3

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( A, B ) View from the 6R portal. Pass one of the ends of the implant suture through the rest of the SLL with the help of the nitinol loop. ( C, D ) The two ends of the suture are tied with a sliding knot over the implant, leaving a simple stitch through the SLL and do not cut the tied sutures. L, lunate; R, radius; SC, scaphoid; SLL, scapholunate ligament.

More than one implant may sometimes be necessary to complete the repair of the dorsal aspect of the SLL, depending on the configuration of the injury. The position of the implants in the scaphoid, the lunate, or both, will depend on the location and characteristics of the rupture. The sutures of one implant will then be used for the subsequent dorsal plication.

From the MCU portal, the correct alignment and stability of the scaphoid and lunate bones are checked.

2. Dorsal capsulodesis (dorsal capsular reinforcement)

With the scope in the 6R portal, an 18G needle is introduced with a Nylon suture inside through the 3–4 portal, directing it from the proximal border of the SLL toward the midcarpal joint, through the ligament tissue ( Fig. 4 ). From the MCU portal, we check that the needle with the suture crosses the SLL through to the midcarpal space. The Nylon suture is pushed through the needle and recovered through the MCR portal ( Fig. 4 ). As a result, one end of the Nylon suture will enter the 3–4 portal, crossing the SLL from the radiocarpal space through to the midcarpal joint and exiting through the MCR portal. This Nylon suture is used to pass one of the ends of the implant suture through to the midcarpal space and to recover it through the MCR portal ( Fig. 4 ). The MCR suture is recovered from the 3–4 portal incision through the space in between the dorsal capsule and the extensor tendons ( Fig. 5 ). As these portals are created in the radial edge of the extensor digitorum communis (EDC) and the suture is recovered parallel to the tendons, the risk of trapping the EDC tendons in the suture is very low.

Fig. 4.

Fig. 4

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( A, D ) View from the MCU portal. Through the 3 to 4 portal an 18G caliber needle with a nylon suture inside is introduced, aiming it from the proximal edge of the SLL to the midcarpal joint, through the ligament's tissue. ( B, E ) The nylon suture is recovered through the MCR portal. ( C, F ) This nylon suture is used to pass one of the implant suture ends through to the midcarpal space to the MCR portal. MCR, midcarpal radial; MCU, midcarpal ulnar; SLL, scapholunate ligament.

Fig. 5.

Fig. 5

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( A–C ) The MCR suture is recovered from the 3 to 4 portal incision through the space in between the dorsal capsule and the extensor tendons; ( D–F ) With the scope in the 6R portal, the implant sutures are tied again, withdrawing the traction. The closure of the dorsal SL interval with the capsular plication performed by reconstructing the dorsal capsuloligamentous union of the scapholunate ligament complex can be seen. MCR, midcarpal radial; SL, scapholunate.

3. Finalization of the capsuloligamentous suture

With the scope in the 6R portal, the implant sutures are tied again, withdrawing traction. The closure of the dorsal interval of the SL with the capsular plication performed by reconstructing the dorsal capsuloligamentous union of the SLL complex can be seen ( Fig. 5 ).

Consequently, a simple suture of the SL ligament over its insertion in the scaphoid or the lunate is achieved, complemented by a dorsal arthroscopic capsulodesis.

KW are used to pin the scaphoid and lunate bones and protect the suture performed.

4. Postoperative period

After surgery, a forearm splint is placed that allows the patient to move fingers and elbow. After 2 weeks, the stitches are removed, maintaining the forearm splint up to 4 weeks, when the secondary KW is removed and movable wrist brace is placed. Four weeks postoperatively, after removing the forearm splint, the patient starts specific rehabilitation treatment. 22

Statistical Analysis

The data have been included in a database created in Microsoft Excel 2013. The statistical analysis was performed with the help of the IBM SPSS program version 24. It consisted of a descriptive analysis of the variables, calculating distribution of frequencies for the qualitative variables and the arithmetic mean and standard error of the mean for the quantitative variables. Statistical comparisons were made with a one-way ANOVA (analysis of variance) with a post-hoc Bonferroni multiple comparison test to determine the statistically significant differences between the means at different evaluation time points. Values of p  < 0.05 were considered to be statistically significant.

Results

Nineteen patients with an acute injury of the SLL were studied, treated with arthroscopic suturing of the SLL with the above-mentioned dorsal capsulodesis procedure. The mean age of patients was 44 ± 2 years (range 31–57), and 74% were male. Fifty-eight percent of patients had injured their right hand. Thirty-seven percent had an associated distal radius fracture and one patient had associated perilunate dislocation. SLL rupture was complete in 58% of the patients, whereas 42% had a partial dorsal rupture. Table 1 lists the types of SLL injury according to the Geissler and EWAS (European Wrist Arthroscopy Society) classifications.

Table 1. Type of SLL injury according to the Geissler and the EWAS (European Wrist Arthroscopy Society) classifications.

Type of SLL injury according to the Geissler classification
Type 2 4
Type 3 8
Type 4 7
Type of SLL injury according the EWAS (European Wrist Arthroscopy Society) classification.
Type 2B 3
Type 2C 1
Type 3C 8
Type 4 7
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Abbreviation: SLL, scapholunate ligament.

No significant differences were observed between the variables studied depending on the injured side.

Pain was measured with a VAS and there was a statistically significant improvement between the pre- and postoperative measurements, with a significant difference between the 12-month and 6-month evaluations ( Fig. 6 ).

Fig. 6.

Fig. 6

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Evaluation of pain using the visual analog scale before the surgery (0 months) and during the postoperative course (6 and 12 months). The data are expressed as mean ± SEM. Significantly different, ** p  < 0.01, *** p  < 0.001.

In the preoperative evaluation, patients presented with reduced grip strength of 57.7 ± 5.3%, with a statistically significant improvement at 6 and 12 months, and another statistically significant improvement between the 6th and the 12th month. A reduction of 12.7 ± 2.4% in strength compared with normality was observed at 12 months; in absolute values, grip strength improved from 13.7 ± 1.3 kg at the preoperative measurement to 30.8 ± 1.1 kg ( Fig. 7a ). The absolute value of grip strength was significantly higher ( p  < 0.001) in males than in females at 12 months; however, there were no statistically significant differences between the two sexes in the reduction of grip strength compared with normality. The preoperative range of motion showed a statistically significant improvement with the intervention at 6 and 12 months, and there was also a statistically significant improvement between the 6th and 12th month ( Fig. 8 ).

Fig. 7.

Fig. 7

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Evaluation of grip strength before the surgery (0 months) and during the postoperative course (6 and 12 months). The results are expressed as absolute values ( A ) and as a reduction in percentage compared with normality ( B ). Significantly different, ** p  < 0.01, *** p  < 0.001.

Fig. 8.

Fig. 8

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Evaluation of range of joint motion ( in degrees ) before the surgery (0 months) and during the postoperative course (6 and 12 months). Significantly different, ** p  < 0.01, *** p  < 0.001.

The functional evaluation performed using the QuickDASH Score ( Fig. 9 ) and the MWS ( Fig. 10 ) improved significantly between the preoperative situation and the evaluations at 6 and 12 months, and the improvement between the 6th and the 12th month was also statistically significant with the QuickDASH Score. The functional evaluation measured with the MWS was significantly better ( p  < 0.05) in the group of patients that did not have an associated fracture at 6 and 12 months. The MWS evaluation was also significantly better ( p  < 0.05) at 6 months in patients who had a partial injury compared with those who had a complete injury, and in patients with Geissler type II lesions versus those with Geissler type IV. At 12 months, 79% of the patients presented with good or excellent results according to the functionality scales and 10.5% had satisfactory results.

Fig. 9.

Fig. 9

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Results of the functional evaluation with the QuickDASH Score before the surgery (0 months) and during the postoperative course (6 and 12 months). Significantly different, ** p  < 0.01, *** p  < 0.001.

Fig. 10.

Fig. 10

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Results of the functional evaluation with the Mayo Wrist Score before the surgery (0 months) and during the postoperative course (6 and 12 months). Significantly different, *** p  < 0.001.

Two patients had a poor outcome and needed a second operation. In both cases, arthroscopy-assisted ligamentoplasty was performed for axial and dorsal reconstruction of the SLL, described by Carratalá et al in 2016. 23

No other complications were reported in the rest of the cases.

Discussion

SL dissociation is the most common cause of acquired carpal instability. The natural course of SL dissociation without treatment is still unclear. What has been demonstrated by several studies is that the treatment of acute SLL injuries generally yields better results than treatment of chronic lesions. 6 The ideal time for performing a repair in the acute phase is not well defined: the intercarpal ligaments degenerate rapidly in the first 2 to 6 weeks, after which primary repair or reinsertion may be difficult, and with an often poor result due to poor tissue quality and poor healing capacity. 24 However, the difficulty of diagnosing isolated acute injuries means that in the majority of cases, treatment is performed when the acute phase has already passed. This handicap is different in cases of distal radius fractures treated with arthroscopic assistance, in which the percentage of associated injuries involving the SLL is high (16–40%) 25 and an adequate diagnosis could be made early on to proceed to a potentially more effective treatment.

The importance of treating in the acute phase has frequently been highlighted in the literature. In a series of 17 patients treated in the nonacute phase (22 weeks after the injury), Pomerance 26 published poor functional results and only three patients were able to resume their previous activities (17.64%), while Rohman et al 27 observed a significantly lower percentage of reinterventions in patients treated in the acute phase (4%) compared with those treated in the chronic phase (18%), taking the acute phase to be the first 6 weeks following the injury and a tendency, though not significant, to superior radiographic results with less SL gap and a smaller SL angle, with a lower QuickDASH score compared with patients treated after 6 weeks. A study by Whipple 12 reported results of arthroscopic treatment of SL dissociation via arthroscopic reduction and fixation with multiple KW and also showed greater maintenance of reduction and symptom relief in the group of patients treated within 3 months of sustaining the injury, and highlighted the need for early diagnosis and treatment of acute SLL instability, and a reduced healing capacity after the lesion becomes chronic.

Restoration with preservation of the anatomy and function of the SLL after traumatic dissociation is a formidable challenge for hand surgeons. The literature contains innumerable references in this respect, relating to a great variety of surgical procedures that aim to restore the interrupted carpal architecture. Zarkadas et al conducted a survey of 468 hand surgeons on the management of acute and chronic SLL instability. 28 In acute cases, the procedures that involved the tissues (97%) were favored although a huge variety in surgical procedures was seen, with more than 20 different procedures. However, the results published on these techniques have been contradictory and confusing due to the enormous variability of techniques and there is no consensus regarding optimal management of this condition. On the other hand, and in accordance with the basic principle of all ligament conditions, acute injury with direct repair of the SLL offers optimal conditions for a favorable result. Early surgery, preferably within the first 3 weeks following the injury, is fundamental for achieving the best possible recovery. 29

The preferred open surgery method for treating acute injuries is direct repair of the ligament using bone anchors or transosseous tunnels, sometimes in combination with dorsal capsulodesis and fixation with KW. 30 In the survey by Zarkadas et al 28 more than two-thirds of the interviewees preferred direct repair with (44%) or without (33%) associated dorsal capsulodesis. However, the arthroscopic techniques described to date for acute injuries did not reproduce the open surgery treatment and in many cases were limited to arthroscopic reduction and fixation with KW. 11 After publication of their studies, Mathoulin et al 20 demonstrated that arthroscopy-guided dorsal capsuloplasty gave promising results in the short-term with regards to improving pain, mobility of the wrist, strength, and reduction in the SL angle. With the development of arthroscopy techniques, it is now possible to perform a treatment similar to that described for open surgery, with reinsertion of the dorsal portion of the SL ligament and to add dorsal capsular reinforcement over the repair performed, 22 thereby reproducing DCSS described as an important element in SL stability. 31

Acute injuries of the SLL usually fall into García Elías type II category, 2 a complete tear with a repairable dorsal ligament and good carpal alignment. Moreover, the injury occurs more frequently at the insertion on the scaphoid, in approximately 40% of the cases. 32

The results published on SL reinsertion using open surgery have been satisfactory in regard to SL stability when the treatment was performed in the acute phase of the lesion. 26 33 34 35 However, the treatment has been linked to greater joint stiffness and restricted motion due to the surgical approach, scarring, and association of dorsal capsulodesis. 33 34

Bickert et al 33 published the results of 12 patients with acute injury of the SLL treated with open repair, a mean of 40 days after the injury and with a follow-up of 19 months. They obtained eight good or excellent results (66.6%), two satisfactory results, and two poor results. Motion was reduced to 78%, and grip strength to 81% compared with the contralateral hand. Rosati et al 34 published the results of a series of 18 patients treated in the acute phase with open SL reinsertion, with a mean follow-up of 32 months (9–68). They obtained excellent results in 13 cases (72.22%), good results in three cases (16.66%), and poor results in two cases (11.11%).

The reduction in the range of joint motion also appeared in the results of Minami et al, 35 in a series of 17 patients in whom direct repair and Blatt capsulodesis were performed, with 70% flexion motion and 87% extension motion. The radiographic results were good in patients treated during the acute phase and poor in the three patients treated at a later stage. The reduction in the range of joint motion was also reported by Szabo 15 as one of the main points against open repair due to the scarring and rigidity caused by the dorsal approach, with a reduction of almost 20% in range of joint motion compared with the contralateral side.

In our study, the percentage of good or excellent results was high at almost 79% of patients (six excellent and nine good). It was superior to most of the published results. Analyzing the results, it is clear that the reduction in range of motion is markedly lower than that published in the above-mentioned papers, with a mean loss of only 10 degrees (0 to 20degrees) compared with the contralateral wrist, probably due to the lower degree of soft tissue aggression, less scar tissue, and the fact that the dorsal reinforcement performed is much more selective and limited in space than that performed using open capsulodesis techniques.

In our series, the cases that required a second surgery due to a poor outcome with the initial suture and symptomatic instability of the carpus corresponded to patients who were treated at a later stage, 31 and 48 days after onset of the injury, probably related to loss of healing capacity after the first week, whereby we believe that treatment of acute injuries in the first 2 to 3 weeks 22 gives good results with regard to pain, grip strength, motion, and functional outcomes ( Fig. 11 ).

Fig. 11.

Fig. 11

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Clinical case. ( A, B ) Perilunate dislocation; ( C, D ) X-ray result after arthroscopic reduction and scapholunate suture. ( E, F ) X-ray results after 12 months of follow-up.

Arthroscopic repair of the SLL with dorsal capsular reinforcement has the advantage of avoiding the above-mentioned aggressions of the soft tissues and makes possible to perform reliable and stable primary repair of the dorsal aspect of the ligament in cases of acute or subacute SL injury where there is tissue which can potentially be repaired. The use of 3–4, 6R, MCU and MCR arthroscopic portals avoids injuring the PIN, minimizes damage to the dorsal vascularization of the SLL complex and avoids injury of secondary stabilizers. All of this can help the ligament to heal after primary repair and to recover motion and function of the wrist. The use of bone anchors for repair and their placement on the border of the injury provides greater resistance to the suture and reinsertion. The association of a plication or dorsal capsular reinforcement, reconstructing the dorsal capsuloligamentous union, increases resistance and stability of the SL.

Conclusion

The arthroscopic technique for repair/reattachment of the SLL with dorsal capsular reinforcement, allows a reliable and stable primary repair of the dorsal aspect of the ligament in acute or subacute SL injuries where there is tissue that can potentially be repaired, thus achieving an anatomical repair similar to that obtained with open surgery, but without the complications and stiffness secondary to the injury of the soft tissues which is inherent to the open dorsal approach.

Funding Statement

Funding None.

Conflict of Interest None declared.

Note

This study was performed in Unidad de Cirugía de Mano y Miembro Superior. Hospital Quirónsalud Valencia. Valencia, Spain.

Ethical Approval

This study was approved by the Ethics Committee of the Hospital Quirónsalud Valencia.

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