We use cookies to offer you an optimal experience on our website. By browsing our website, you accept the use of cookies.
Filter by
Specialty
View more
Clear filter Media type
View more
Publication date
Sort by:
Arthroscopic dorsal capsuloplasty as treatment for chronic scapholunate tear
The sprain of the scapholunate ligament generates chronic instability, which leads to a chondral change with carpus arthritis. The use of wrist arthroscopy allows the diagnosis of these lesions, even at an early stage, and, sometimes, provides a therapeutic strategy by performing a stable fixation. In some chronic cases when the ligament cannot be repaired but the scapholunate space is reducible (stage 2 to 4 according to Garcia-Elias’ classification), a new arthroscopic dorsal capsuloplasty has been performed in order to avoid a complex reconstruction with common stiffness. The patients were operated on in outpatient settings under regional anesthesia using a pneumatic tourniquet. The capsuloplasty is arthroscopically performed between the dorsal capsule and the dorsal part of the scapholunate ligament, using a PDS suture loop. Scapholunate and scaphocapitate Kirschner wires are placed only at stage 4 after scaphoid reduction. A volar splint was placed for a period of 2 months.
C Mathoulin
Surgical intervention
8 years ago
854 views
5 likes
0 comments
12:38
Arthroscopic dorsal capsuloplasty as treatment for chronic scapholunate tear
The sprain of the scapholunate ligament generates chronic instability, which leads to a chondral change with carpus arthritis. The use of wrist arthroscopy allows the diagnosis of these lesions, even at an early stage, and, sometimes, provides a therapeutic strategy by performing a stable fixation. In some chronic cases when the ligament cannot be repaired but the scapholunate space is reducible (stage 2 to 4 according to Garcia-Elias’ classification), a new arthroscopic dorsal capsuloplasty has been performed in order to avoid a complex reconstruction with common stiffness. The patients were operated on in outpatient settings under regional anesthesia using a pneumatic tourniquet. The capsuloplasty is arthroscopically performed between the dorsal capsule and the dorsal part of the scapholunate ligament, using a PDS suture loop. Scapholunate and scaphocapitate Kirschner wires are placed only at stage 4 after scaphoid reduction. A volar splint was placed for a period of 2 months.
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
C Mathoulin
Surgical intervention
1 year ago
156 views
3 likes
0 comments
09:08
Arthroscopic capsuloligamentous suture with anchor for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened. Sometimes, the scapholunate ligament is avulsed from the dorsal proximal pole of the scaphoid, and it is necessary to put an anchor at the exact location of the scapholunate attachment into the dorsal scaphoid to allow a dorsal capsuloligamentous repair as for a classical scapholunate tear.
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
C Mathoulin
Surgical intervention
1 year ago
118 views
4 likes
0 comments
06:06
Arthroscopic large dorsal capsuloligamentous suture for scapholunate dissociation EWAS stage 4
An anatomical and biomechanical study has recently shown that detachment of the scapholunate (SL) ligament from the dorsal capsuloligamentous scapholunate septum (DCSS) and dorsal intercarpal ligament (DIC) worsens scapholunate dissociation. This knowledge has revolutionized the treatment of scapholunate dissociation and formed the basis of the arthroscopic repair of the scapholunate ligament complex. SL ligament repair per se is not adequate; it has to be reattached to the dorsal capsule. This is enabled with an arthroscopic technique, which preserves the dorsal capsule. In some large dissociation, we can use a trick, catching a largest part of the dorsal capsule, proximally and distally, in order to help scapholunate reduction when the knot is tightened.
Management of scapholunate tears: open versus arthroscopic treatment
The understanding of scapholunate ligament lesions has made great strides in recent years, largely thanks to the work undertaken by the two wrist surgery "heavyweights" who are Dr. Marc Garcia-Elias and Dr. Christophe Mathoulin.
Although they do not use the same approach to treat scapholunate ligament lesions (Marc Garcia-Elias opens the wrist and Christopher Mathoulin tries to process them arthroscopically), they have both reached the same conclusion:
- the scapholunate ligament is more than just an interosseous ligament but rather a real scapholunate ligament complex with intrinsic and extrinsic components;
- proprioception is involved in the stability of scapholunate space;
- and early diagnosis and treatment seem essential to obtain good results.
This peer-to-peer conversation between these two friends is not a battle, but rather an extremely modern development on a long debated topic... have fun!
Moderator: Riccardo Luchetti, MD
M Garcia-Elias, C Mathoulin, R Luchetti
Lecture
7 years ago
647 views
3 likes
0 comments
37:58
Management of scapholunate tears: open versus arthroscopic treatment
The understanding of scapholunate ligament lesions has made great strides in recent years, largely thanks to the work undertaken by the two wrist surgery "heavyweights" who are Dr. Marc Garcia-Elias and Dr. Christophe Mathoulin.
Although they do not use the same approach to treat scapholunate ligament lesions (Marc Garcia-Elias opens the wrist and Christopher Mathoulin tries to process them arthroscopically), they have both reached the same conclusion:
- the scapholunate ligament is more than just an interosseous ligament but rather a real scapholunate ligament complex with intrinsic and extrinsic components;
- proprioception is involved in the stability of scapholunate space;
- and early diagnosis and treatment seem essential to obtain good results.
This peer-to-peer conversation between these two friends is not a battle, but rather an extremely modern development on a long debated topic... have fun!
Moderator: Riccardo Luchetti, MD
Arthroscopic-assisted scapholunate ligament reconstruction for chronic SL instability
Both the dorsal and the volar portion of the scapholunate interosseous ligaments are the major stabilizers of the scapholunate joint. Most conventional methods to restore scapholunate stability do not address the volar constraints and frequently fail to reduce the SL gapping. Wrist arthroscopy allows for a complete evaluation of the SL interval, accompanying ligament status and associated SLAC wrist changes. It enables simultaneous reconstruction of the dorsal and palmar scapholunate ligaments anatomically with the use of the palmaris longus tendon as a tendon graft in a box-like structure.

With the assistance of arthroscopy, a combined limited dorsal and volar incision can expose the dorsal and palmar scapholunate interval, where bone tunnels can be made by a cannulated drill under image control on the proximal scaphoid and lunate. The palmaris longus tendon graft is then used to reduce and connect the two bones in a box-like fashion. Once joint diastasis has been reduced and DISI malrotation has been corrected, the tendon graft can be knotted under maximal tension on the dorsal surface of the scapholunate joint in a shoe-lacing manner. Correction and control of the DISI deformity can be achieved by placing drill holes at different levels, more proximally over the lunate and distally over the scaphoid to counter-rotate the deformity. Either the scapholunate or the scaphocapitate joint is then transfixed using K-wires for temporary protection of the reconstruction.

From October 2002 to June 2009, the treatment method was applied in 8 patients suffering from chronic SL instability with an average duration of 7.4 months (3-9 months). There were 6 male and 2 female patients. The average age for this group was 45.4 years (34-60 years). Six of the injured wrists were right wrist injuries. There were two Geissler grade 3 and six grade 4 instability cases. The average pre-operative SL interval was 4.7mm (3-9mm). Concomitant procedures were performed in 4 patients. The average follow-up was 34.9 months (10-66 months).

Symptoms in all patients —except in one— either improved or completely disappeared. The functional wrist score improved from 23.1 to 34.4 on a 40-point scale. Pain score decreased from 12 to 4.4 on a 20-point scale. There was no pain in 5 patients and exertion pain in 3. The injured/uninjured grip power ratio improved from 73.9% to 89%. The average SL interval at final follow-up was 3.6mm (2-7mm). An ischemic change of the proximal scaphoid was noted in one case without symptoms or progression. There were no major complications. All patients —except one— were satisfied with the procedure and the treatment outcome.
PC Ho
Lecture
7 years ago
418 views
7 likes
0 comments
17:25
Arthroscopic-assisted scapholunate ligament reconstruction for chronic SL instability
Both the dorsal and the volar portion of the scapholunate interosseous ligaments are the major stabilizers of the scapholunate joint. Most conventional methods to restore scapholunate stability do not address the volar constraints and frequently fail to reduce the SL gapping. Wrist arthroscopy allows for a complete evaluation of the SL interval, accompanying ligament status and associated SLAC wrist changes. It enables simultaneous reconstruction of the dorsal and palmar scapholunate ligaments anatomically with the use of the palmaris longus tendon as a tendon graft in a box-like structure.

With the assistance of arthroscopy, a combined limited dorsal and volar incision can expose the dorsal and palmar scapholunate interval, where bone tunnels can be made by a cannulated drill under image control on the proximal scaphoid and lunate. The palmaris longus tendon graft is then used to reduce and connect the two bones in a box-like fashion. Once joint diastasis has been reduced and DISI malrotation has been corrected, the tendon graft can be knotted under maximal tension on the dorsal surface of the scapholunate joint in a shoe-lacing manner. Correction and control of the DISI deformity can be achieved by placing drill holes at different levels, more proximally over the lunate and distally over the scaphoid to counter-rotate the deformity. Either the scapholunate or the scaphocapitate joint is then transfixed using K-wires for temporary protection of the reconstruction.

From October 2002 to June 2009, the treatment method was applied in 8 patients suffering from chronic SL instability with an average duration of 7.4 months (3-9 months). There were 6 male and 2 female patients. The average age for this group was 45.4 years (34-60 years). Six of the injured wrists were right wrist injuries. There were two Geissler grade 3 and six grade 4 instability cases. The average pre-operative SL interval was 4.7mm (3-9mm). Concomitant procedures were performed in 4 patients. The average follow-up was 34.9 months (10-66 months).

Symptoms in all patients —except in one— either improved or completely disappeared. The functional wrist score improved from 23.1 to 34.4 on a 40-point scale. Pain score decreased from 12 to 4.4 on a 20-point scale. There was no pain in 5 patients and exertion pain in 3. The injured/uninjured grip power ratio improved from 73.9% to 89%. The average SL interval at final follow-up was 3.6mm (2-7mm). An ischemic change of the proximal scaphoid was noted in one case without symptoms or progression. There were no major complications. All patients —except one— were satisfied with the procedure and the treatment outcome.
Scapholunate tears: a new classification
Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.
J Messina
Lecture
8 years ago
268 views
1 like
0 comments
08:46
Scapholunate tears: a new classification
Pathogenesis and treatment of scapholunate (SL) injuries are still under definition in the literature, especially in chronic cases. A two-stage mechanism able to create a chronic injury has been described by several authors. A partial initially asymptomatic injury to the SL ligament can later become symptomatic. The treatment of these injuries is not standardized in the different stages and not always satisfactory. Lack of early diagnosis of this injury can develop a chronic instability leading to degenerative arthritis and SLAC wrist. The aim of this study is to experimentally cut the different parts of the scapholunate ligament and extrinsic ligaments in cadaveric wrists and check the corresponding arthroscopic finding. The SL ligament was evaluated at the beginning of the dissections. Extrinsic ligament tension or laxity was also assessed arthroscopically and by specific tests. A new classification by the European Wrist Arthroscopy Society (EWAS) is proposed to better define the different stages and improve treatment.