This is a retrospective study of 32 patients that had persistent wrist pain following an injury at an average of 13 years of age (range, 6.7 to 17.3 years) that ultimately underwent wrist arthroscopy and were found to have partial scapholunate ligament tears that were debrided. All patients were initially treated for 4-6 weeks with cast immobilization followed by supervised therapy. The average interval between the injury and arthroscopy was 24 months (range, 6 months to 5.4 years). The average age at the time of surgery was 15 years (range, 11 to 18 years). Seventeen patients had an acute traumatic event and 15 patients had a repetitive overuse injury. Findings at the time of surgery included 30 type-II Geissler tears and 2 type-III Geissler tears. Twelve patients had a TFCC injury, 1 patient had a lunotriquetral tear, 7 had a partial tear of the short radiolunate ligament, and 27 patients had a chondral injury. Only 1 patient had an isolated scapholunate ligament injury without either a chondral injury, TFCC tear, or other intercarpal ligament abnormality. Fourteen patients had one or more procedures in addition to the debridement of the scapholunate ligament which included 7 TFCC repairs, 5 ulnar shortening osteotomies, 3 microfracture treatments of chondral lesions, 2 ulnar styloid nonunion excisions and 1 ulnar nerve decompression at the wrist. The average Mayo wrist score improved from 66 preoperatively to 92 at an average of 43 months of follow up. Eight patients required subsequent surgery, because of deterioration in their clinical status: 6 underwent open reconstruction with a dorsal capsulodesis and 2 had repeat arthroscopic debridements. The 2 patients with a Geissler type-III scapholunate ligament tear ultimately underwent an open reconstruction.
This present study shows that adolescents with persistent wrist pain with a partial Geissler type-II scapholunate ligament tear can be effectively treated with arthroscopic debridement. However, nearly half of these patients had additional procedures performed in addition to scapholunate ligament debridement. Preoperative MRIs were not very sensitive or specific for detecting either the ligament tears or chondral injuries. However, the authors found that when the preoperative MRI was positive, preoperative planning, decision making and parental counseling were more effective. The authors postulate that pain related to these membranous regions of the scapholunate ligament may be secondary to impingement of the tear on the chondral surface of the lunate fossa and have a poor healing potential which ultimately allows for effective treatment with arthroscopic debridement. The authors currently recommend open reconstruction for Geissler type-III and IV scapholunate ligament ruptures and concomitant arthroscopic evaluation to detect common associated ligament and chondral injuries. More long-term follow up data may be beneficial to detect long-term sequelae of these injuries.
Arthroscopy, Wrist, Debridement, Children, Partial, Ligament, Scapholunate
Journal of Bone and Joint Surgery