Surgical Treatments for Scapholunate Ligament Injuries and Development of Arthritis in the Wrist: A Systematic Review.

PURPOSE: The scapholunate ligament (SLL) is the most injured carpal ligament; however, surgeons do not agree on the best management. Several studies have reported on the after surgery functional outcomes of different surgical techniques, with varying results. However, there is little literature on the development of arthritis in the context of a SLL injury. The goal of this review was to examine the current literature to investigate the relationship between an SLL injury and the development of arthritis in the wrist and hand.

METHODS

We performed a systematic literature review on surgical treatments for SLL injuries. This review included 37 studies that met the inclusion criteria for treatment outcomes and arthritis development. We reported both demographic and radiological results, which included arthritis prevalence and pattern. Methodological quality was assessed using the Downs and Black checklist.

RESULTS

In total, 784 injured wrists were analyzed across the 37 studies, and postoperative arthritis occurrences across treatment types were as follows, capsulodesis (10.6%), tenodesis (13.6%), ligamentoplasty (14.6%), bone-ligament-bone (31.5%), and debridement (5.3%), with scapholunate advanced collapse III being the most common arthritic pattern. The mean age of patients was 39.8 years. The delay between injury and treatment averaged 13.2 months.

CONCLUSIONS

Our systematic review highlights the variability in arthritis patterns following SLL injuries and underscores the lack of consensus regarding management strategies. We observed the highest rates of arthritis using the bone-ligament-bone method and the lowest rates using the debridement technique.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IIA.