Arthroscopic Resection and Spongioplasty of Scapholunate Joint in Treating Chronic Dynamic Scapholunate Instability

作者：Cizmar I.^*; Kovarik J.; Vlcek M.; Korpa P.

来源：Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, 2018, 85(1): 34-39.

• wrist
• instability
• scapholunate joint
• arthroscopy
• bone graft

PURPOSE OF THE STUDY
The study evaluated the method of arthroscopic stabilisation of dynamic scapholunate (SL) instability by scapholunate joint resection using bone graft to create synarthrosis between the scaphoid and lunate.
MATERIAL AND METHODS
Twenty-six patients with chronic dynamic SL instability of Geisler-Messina - EWAS grade IIIB, C and IV were treated by artificial synarthrosis of SL joint using an arthroscopic technique. The mean follow-up period of the patients was 32.2 months (28-39 months, when the range of motion and grip strength were assessed. The functional results were evaluated through the Mayo wrist score.
RESULTS
Post-operatively, a statistically significant improvement in grip strength was reported, with the mean improvement of 9 kg. On the other hand, significant worsening of flexion with a mean change of -6 degrees, a mean change in extension of -5 degrees and ulnar deviation -2 degrees were identified. According to the visual analogue scale, there was a significant reduction in pain associated with everyday activity (mean change -4) as well as with heavy manual work (mean change -4). According to the Mayo wrist score, the overall results in 3 patients were excellent, in 16 patients good, in 6 patients satisfactory, and in one patient poor.
DISCUSSION
A limited range of motion significantly influencing the overall results of the functional assessment on the Mayo wrist score does not have a substantial subjective impact on patients and their routine activities. All the studies evaluating the operative techniques restoring stability of proximal row of the carpal bones report limited range of motion in the wrist. These interventions aim at a strong, pain-free grip with preserved wrist function.
CONCLUSIONS
This study illustrates that the arthroscopic stabilisation of scapholunate joint by synarthrosis is a reliable, minimally invasive surgical method to treat the higher grade of dynamic SL instability. This method makes it possible to achieve good stability of the damaged joint and leads to satisfactory functional results.

• 出版日期2018-2