Arthroscopic Treatment of Scapholunate Instability

Scapholunate interosseous ligaments (SLIL) tears are among the most common and severe ligament injuries associated with wrist trauma and usually occur after a fall on a hyperextended and pronated wrist. The natural evolution leads to chronic scapholunate joint instability and osteoarthritis. Diagnosis and treatment are a real challenge for the surgeon, and inadequate management in early stages is associated with worse functional outcomes. Moreover, SLIL lesions are difficult to evaluate precisely even with the advent of highly accurate imaging techniques. Many conventional open surgical techniques have been described for scapholunate joint stability; however, these procedures often result in stiffness. In the last three decades, wrist arthroscopy has dramatically changed the understanding of these lesions and has led to the development of less invasive and reproducible surgical repair techniques. Among the stabilizers, the dorsal part of the SLIL and the dorsal capsulo-scapholunate septum (DCSS) has emerged as the key components of SL joint stability. The techniques described here enable repair of these two structures by a capsule-to-ligament suturing and prevent stiffness observed in the open procedures.