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Scapholunate and lunotriquetral ligament reconstruction with internal brace and tendon grafting
Indications
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In young individuals without arthritis, attempts at reconstruction rather than salvage should be pursued to recreate the scapholunate and lunotriquetral ligaments.
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Internal brace and tendon grafting is an option to reconstruct various stages of scapholunate (SL) ligament injury without articular wear, in particular in association with lunotriquetral (LT) ligament dissociation. In cases with both SL and LT ligament tears, proximal row carpectomy is a suitable option, but if the articular surfaces are intact, it is preferable to stabilize the ligaments to preserve carpal mechanics.
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Ulna shortening should be performed at the time of surgery if the LT tear and instability are secondary to ulnar positive variance to prevent retear of the reconstructed ligament.
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Additionally, the triangular fibrocartilage complex (TFCC) should be examined carefully because LT tears are often associated with degenerative tears of the TFCC.
Contraindications
If SL injury has already led to scapholunate advanced collapse (SLAC) arthritis, or articular wear is present at the LT joint, then salvage options, including proximal row carpectomy, scaphoid excision, and four-corner fusion or wrist arthrodesis, should be explored. Otherwise, these patients will likely experience pain and dysfunction as a result of their arthritis.
Clinical examination
See Chapter 21 (Scapholunate Ligament Repair) and Chapter 23 (Lunotriquetral Ligament Reconstruction using Tendon Grafts)
Imaging
See Chapter 21 and 23 .
Surgical anatomy
See Chapter 21 and 23 .
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