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Cable-augmented, Quad Ligament Tenodesis Scapholunate Reconstruction: Rationale, Surgical Technique, and Preliminary Results

Bain, Gregory I. MD*,†,‡; Watts, Adam C. MBBS*,§; McLean, James MBBS, MS*,†,‡; Lee, Yu C. MBBS*,†; Eng, Kevin MBBS*,†

Techniques in Hand & Upper Extremity Surgery: March 2013 - Volume 17 - Issue 1 - p 13–19
doi: 10.1097/BTH.0b013e31827204ba

Eight patients underwent scapholunate reconstruction using tensionable suture anchors. Adapted from a modified Brunelli technique, the anchors provide a fixed cable that reduces the scapholunate diastasis and maintains reduction during the healing phase. The flexor carpi radialis tendon graft is advanced through the scaphoid and stabilizes the volar scaphotrapezial ligament, dorsal scapholunate ligament, dorsal intercarpal ligament, and dorsal radiocarpal ligament. The ligament-sparing approach is closed using an ulnar advancement capsulodesis that further reinforces the dorsal intercarpal and dorsal radiocarpal ligament. Good clinical results were obtained. Measured on a visual analog scale (0 to 10), the average pain score improved from 5.8 to 2.1, average patient satisfaction was 7.6, average extension was 56 degrees (91% of contralateral side), flexion was 44 degrees (70% of contralateral side), and grip was strength 41 kg (95% of contralateral side). Radiographic parameters were less favorable. The average scapholunate angle was 71 degrees, radiolunate angle 16 degrees, and scapholunate interval 3.0 mm. The cable-augmented, quad ligament scapholunate ligament reconstruction offers theoretical advantages over previously published techniques, but long-term follow-up is required.

*Department of Orthopaedics, Modbury Public Hospital

Department of Orthopaedics and Trauma, Royal Adelaide Hospital

Discipline of Orthopaedics and Trauma, University of Adelaide, Adelaide, South Australia, Australia

§Department of Orthopaedics, Wrightington Hospital, Lancashire, UK

Conflicts of Interest and Source of Funding: The authors report no conflicts of interest and no source of funding.

Address correspondence and reprint requests to Gregory I. Bain, MD, 196 Melbourne Street, North Adelaide 5006, South Australia, Australia. E-mail:

© 2013 Lippincott Williams & Wilkins, Inc.