1 Introduction topenlarge
Rupture of the scapholunate ligament is the first event in any sequence of perilunar ligament ruptures. It is the most common pattern of wrist instability.
Its characteristics are the dissociation of the scaphoid and the lunate, with flexion of the scaphoid, and extension of the lunate.
The reconstruction of rotational stability between the scaphoid and the lunate is the key to restoring normal wrist kinematics.
2 Reduction topenlarge
Two joystick K-wires are inserted into the scaphoid and the lunate.
They are used to reduce the scapholunate joint.
Assessment of dorsal and proximal ligament parts
In most of the cases, the SL ligament is avulsed from the scaphoid, and still in contact with the lunate.
The avulsion site is debrided for better contact and healing.
3 Suture anchors topenlarge
A suture anchor is inserted into the debrided area of the avulsion.
The suture anchor must be placed in position slightly oblique to resist rotational forces between both bones (the scaphoid should be pulled from flexion, or the lunate from extension).
The anchor is placed distally in the scaphoid, or proximally in the lunate.
Often, one anchor will be sufficient, but occasionally two anchors will be needed.
The suture is inserted into the ligament proximally when it is attached to the lunate, and distally when it is attached to the scaphoid.
4 Option topenlarge
If bone anchors are not available, the avulsed ligament is attached using sutures which are passed through small tunnels drilled into the proximal pole of the scaphoid, as illustrated.
5 Anatomical reduction topenlarge
Use the two joysticks to extend the scaphoid, flex the lunate, and then close the gap.
A pointed reduction clamp helps to secure the reduction temporarily.
Confirm reduction using image intensification.
Both bones are secured in position by transfixation with two K-wires inserted percutaneously from scaphoid to lunate.
Again, confirm the position of both wires using image intensification.