The association between acute scaphoid fractures and concomitant scapholunate ligament (SLL) injuries has historically been underestimated, yet failure to recognize these lesions may lead to carpal instability, scaphoid nonunion, and long-term degenerative changes. This systematic review synthesizes current evidence on the incidence, diagnostic methods, and management of SLL injuries occurring with acute scaphoid fractures. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Web of Science from inception to April 2025 was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, including original articles in English or French reporting on SLL injuries associated with acute scaphoid fractures. Eleven studies met inclusion criteria, comprising prospective and retrospective cohorts, case-control studies, series, and case reports. Reported incidence of SLL injuries ranged from 0% to 71%, with arthroscopy detecting higher rates than radiography or magnetic resonance imaging. Most lesions were Geissler grades I to III, while complete tears were rare. Management was predominantly limited to scaphoid fixation, with only a minority of cases undergoing concomitant SLL repair or pinning. Outcomes were inconsistent, with some studies showing persistent pain and lower Mayo Wrist Scores, whereas others reported no significant differences. Overall methodological quality was low to moderate. These findings suggest that SLL injuries may complicate acute scaphoid fractures more frequently than previously recognized. Routine arthroscopy is not universally recommended, but selective use based on clinical suspicion and imaging may improve detection. Treatment should be tailored to the grade of injury, and further prospective studies with standardized diagnostic protocols and long-term follow-up are required to clarify prognostic impact and optimize management strategies.
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