A Scaphoid Safety Scapholunate Interosseous Ligament Reconstruction. the Non-Bone Tunnel Technique and Clinical Outcomes

Objective: In the chronic unrepairable scapholunate interosseous ligament (SLIL) injury stage, scapholunate ligament (SL) reconstruction remains the gold standard treatment. However, most surgical techniques are required to make the bone tunnel by drilling through the scaphoid, which may introduce iatrogenic scaphoid fracture as a complication. Thus, the aim of this study was to describe an alternative surgical technique for SLIL reconstruction by using a double anchor suture instead of bone drilling. Materials and Methods: A total of 5 consecutive cases of chronic scapholunate dissociation that underwent the non-bone tunnel technique of SLIL reconstruction were included in the study. The clinical data between the preoperative and postoperative were collected. Results: In 5 cases, a ligament reconstruction was achieved successfully. At 12 weeks after the surgery. The average Visual Analog Scale improved from 8.4 to 1.0. The clinical stress test was negative without pain. The mean grip strength improved to 85.4% compared with the normal contralateral hand. The mean Quick Disabilities of the Arm, Shoulder, and Hand score was 8.62 compared with the preoperative score of 70.92. Mean of SL interval in wrist with anteroposterior view and anteroposterior clenched fist view at 2.50 mm and 2.68 mm. Conclusion: The scaphoid safety SLIL reconstruction technique is a simple and reliable treatment method, using flexor carpi radialis tendon weave and anchor-ligament-anchor procedure instead of previous bone tunnel techniques. Biomechanical strength of the system demonstrated by postoperative results of scaphoid flexion was corrected, but SL gaps were still remaining in some cases. However, there was no effect on clinical outcomes and patient satisfaction.