Résumé
Arthroscopic scapholunate tenodesis for pre dynamic scapholunate instability EWAS 3.
For predynamic scapholunate (SL), denervation have been an option but many papers showed the importance of the proprioceptive function of the NIOP. We evaluated retrospectively the results of arthroscopic scapholunate tenodesis without pinning and a simple cast immobilization post operatively for one month.
Twelve patients (mean age, 36.5years) presenting with persistent posttraumatic pain and weakness to the wrist were diagnosed with pre SL instability (positive Watson scaphoid shift test result, SL gapping on grip-view radiographs, arthroscopic findings of a EWAS III B or C tear) and treated. Range of motion, grip strength, radiographic measurements, and the Mayo wrist score were used to evaluate the results.
The mean delay between trauma and surgery was 19months (range, 2–36). None patients had subsequent surgery before the procedure. The mean follow-up period was 17,7months (range, 3–41). Asymptomatic scapholunate instalibity was noted. The mean EVA score for pain at rest and activities were signicantly better at last follow up, respectively at rest from 6.3 to 0.91, in activities from 7.3 to 2.4. The mean range of motion was 65 degrees of extension to 73.5 degrees of flexion with more than 75% of mean mobility to controlateral side in 83% of patients. The mean QuickDash, PRWE and MWS are: 15.2, 11.2 and 93. No persistent radiographic SL gapping in grip views was noted in all patients but one progressed to dorsal intercalated segment instability.
The results of this technique are suboptimal, however, it may be an conservative option for patients with predynamic painful wrist and prevent from stiffness. This procedure doesn’t cut the way to any further procedure in case of bad result.