Treatment of Scapho-Lunate Dinamic Instability by Arthroscopic Radio-Carpal Ligaments and Dorsal Capsule Suture on Scapho-Lunate Ligament using Mathoulin /EWAS Technique

By Gustavo Ruggiero 7 Videos

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April 30, 2012

This video shows a clinical case of scapho-lunate dynamic instability, diagnosed by arthroscopy and treated ...
read more ↘ by Mathoulin et al Technique, proposing a artrhroscopic Capsulodesis on SL ligament.
This technique was originally described for treatment of SL dissociation, where a partial or complete tear on SL ligament is present, however in my clinical practice I found several patients with dorsal wrist pain, laxity, and often a small dorsal ganglion, in which during the arthroscopy I found a normal SL ligament and a SL instability grade 2, sometimes 3 of Geissler during midcarpal inspection. The important aspect found on this patients is the complete or partial injury of the normal arc found on the attachment of dorsal capsule (including on it the Dorsal Radio Lunate and Dorsal Intercarpal Ligament) on the dorsal component of Scapho-Lunate intrinsic ligament. Gamal et al (Gamal A. Elsaidi, DO; David S. Ruch, MD; Gary R. Kuzma, MD; and Beth Paterson Smith, PhD- Dorsal Wrist Ligaments Insertions Stabilize the Scapho-Lunate Interval: cadaver study. CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, 425, pp. 152–157, 2004) has demonstrated on his cadaver biomechanical tests, this capsular-ligament insertion has a critical role on SL complex stability, and since then we look for the integrity of this insertion on every arthroscopy, and we found this injury often related to symptomatic dorsal ganglion. The patient profile is also commom, in general young female, with joint laxity, and some stressing activities using the hands. In general the symptoms are present for a long time, and no lasting good result with conservative treatment. On MRI sagital views this injury can be noted, and arthroscopic treatment as shown on this video is our actual option. The technique is described by Mathoulin et al (Christophe L. Mathoulin, MD, Nicolas Dauphin, MD, Abhijeet L. Wahegaonkar, MD. Arthroscopic Dorsal Capsuloligamentous Repair in Chronic Scapholunate Ligament Tears. Hand Clin 27, pp 563–572, 2011) for treatment of SL dissociation.
I believe the injury of DRL and DIC ligament insertions on the SL ligament ( I call "Mathoulin's injury") can occur as degenerative or traumatic process, leading to subclinical SL instability and symptoms, promoting the dorsal ganglion ocurrence, and may progress stressing the SL intrinsic ligament by overload, leading to progressive SL degenerative dissociation. On this scenery the technique shown may play an important role preventing this progress.
Further studies are under construction in order to comprove those impressions and feelings.
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Treatment of Scapho-Lunate Dinamic Instability by Arthroscopic Radio-Carpal Ligaments and Dorsal Capsule Suture on Scapho-Lunate Ligament using Mathoulin /EWAS Technique

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