Long-Term Functional Outcomes After Volar Capsulodesis for Treatment of Scapholunate Ligament Injuries: An 18-Year Experience.

PURPOSE: To present our clinical experience with a volar scapholunate (SL) ligament reconstruction using a strip of the long radiolunate ligament.

MATERIALS AND METHODS: This was a single-institution observational study (2004-2022) of SL ligament injuries with evidence of a torn volar component on arthroscopy that received volar capsulodesis with/without a dorsal repair. The postoperative range of motion (ROM), grip strength, complications, and secondary surgery (e.g., four-corner fusion or total wrist fusion), and radiographic changes were reported. Disabilities of arm, shoulder, and hand/patient-rated wrist evaluation (DASH/PRWE) scores were prospectively collected. Patients were stratified by static versus dynamic/predynamic SL diastasis and by isolated volar versus volar and dorsal ligament injury.

RESULTS: Twenty-eight patients (15 females and 13 males) with a mean age of 35.1 years (± 15.7) met the inclusion criteria. The follow-up was 86.3 months (± 53.4; minimum 11 months). Most (26/28) patients were right-handed. The majority (20/28) of the patients presented ≥ 6 weeks postinjury. Few (4/28) used tobacco. Most (20/28) patients had dynamic/predynamic injuries. Postoperatively, the mean pronation/supination was 83 degrees/83 degrees, flexion/extension was 56 degrees/61 degrees, ulnar deviation was 30 degrees, and radial deviation (RD) was 19 degrees ( n  = 13). The mean grip strength was 78.8% (± 30.4) of the contralateral normal side ( n  = 14). Except for increased RD in patients with dynamic/predynamic injuries ( p  = 0.02), there were no other ROM differences. SL widening (>3 mm) postoperatively was observed in 33.3% (2/6) of static versus none of the dynamic/predynamic injuries ( p  = 0.165). There were only two postoperative complications, both surgical site infections. Two patients had persistent pain and required secondary surgery at a median of 48 months. At 86.9 months, patients reported a mean DASH of 16.4 (± 17.8) and a PRWE of 24.6 (± 23.6), and 78.9% (15/19) returned to prior work.

CONCLUSION: We report long-term functional outcomes after a volar capsulodesis for volar SL injuries. This appears to be a safe procedure with an acceptable complication rate and low disability after 7 years. Most (approximately 79%) patients returned to their previous employment. A larger comparative study will be required to prove superiority to other types of repairs.

LEVEL OF EVIDENCE: Level IV, Case series.