Radiographic alignment is not associated with patient-reported symptoms after 360° scapholunate ligament reconstruction.

INTRODUCTION: Reconstruction of the scapholunate interosseus ligament (SLIL) remains a controversial topic, with numerous techniques reported and variable outcomes. However, the factors determining clinical outcomes after reconstruction and the extent to which radiographic alignment influences patient-reported outcomes remain unclear. The aim of this study was to identify variables independently associated with pain intensity and patient-reported function at a minimum of 3 years after 360° SLIL reconstruction. The secondary aim was to determine the variables associated with revision surgery.

METHODS: This retrospective single-centre study included consecutive patients who underwent 360° SLIL reconstruction with a flexor carpi radialis tendon graft between 2010 and 2021. All patients were followed for at least 3 years. Clinical evaluation included grip and pinch strength, wrist range of motion expressed relative to the contralateral side and patient-reported outcomes measured by the Disabilities of the Arm, Shoulder and Hand, Patient-rated Wrist/Hand Evaluation and visual analogue scale for pain. Standardized radiographs were analysed to assess scapholunate distance and scapholunate angle. Associations between demographic, clinical and radiographic variables and patient-reported symptoms and salvage were analysed.

RESULTS: Fifty-three patients (42 men, 11 women) with a median age of 42 years (IQR: 32 to 51) were evaluated after a median of 53 months (IQR: 44 to 85). Overall grip strength and measures of patient reported symptoms improved, while wrist motion decreased. Older age and shorter symptom duration were independently associated with improved patient reported symptoms, while radiographic alignment was not. No variables were associated with revision surgery.

CONCLUSIONS: Radiographic alignment was not independently associated with patient-reported symptoms or revision surgery, suggesting that recovery after SLIL reconstruction may involve factors beyond structural restoration alone, such as accommodation.

LEVEL OF EVIDENCE: IV.