Long-term outcomes of SLIC 2 ligamentoplasty for chronic static scapholunate dissociation: a minimum 5-year follow-up study.

INTRODUCTION: Chronic static scapholunate dissociation remains a therapeutic challenge, and the long-term ability of ligamentoplasty procedures to maintain carpal correction is uncertain. Our hypothesis was that SLIC 2 ligamentoplasty may provide sustained clinical improvement despite partial loss of radiological correction over time. We report the minimum 5-year outcomes of this technique in patients with reducible chronic static scapholunate dissociation.

METHODS: This retrospective case series included seven patients who underwent SLIC 2 ligamentoplasty between April 2014 and June 2019 for Garcia-Elias stage 4 reducible chronic static scapholunate dissociation. All patients were reassessed after a minimum follow-up of 5 years. Preoperative and 1-year clinical and radiological data were collected from medical records, and final outcomes were assessed during standardized long-term reassessment. Radiological assessment included the scapholunate gap, scapholunate angle, capitolunate angle, posterior scaphoid subluxation, and posterior radioscaphoid angle. Clinical assessment included pain, grip strength, range of motion, QuickDASH, PRWE, and Mayo Wrist Score.

RESULTS: At a median follow-up of 72 months (IQR, 69.5-78), the initial radiological correction was progressively lost. Compared with immediate postoperative values, the median scapholunate gap increased from 2.0 mm (IQR, 1.8-2.1) to 4.2 mm (IQR, 4.0-4.4) (p = 0.016), and the scapholunate angle increased from 50° (IQR, 49-64.5) to 80° (IQR, 76-86) (p = 0.016). Despite this radiological recurrence, clinical outcomes remained improved. Pain during effort decreased from 5.5 (IQR, 3.8-7.2) to 2 (IQR, 1-3) (p = 0.031), PRWE improved from 49.5 (IQR, 35.8-52.3) to 16 (IQR, 11.3-23.8) (p = 0.031), and Mayo Wrist Score improved from 70 (IQR, 67.5-77.5) to 80 (IQR, 72.5-82.5) (p = 0.016). One patient developed progressive SLAC arthritis.

CONCLUSION: SLIC 2 ligamentoplasty provided sustained clinical improvement at more than 5 years despite progressive loss of the initial radiological correction. These findings should be interpreted cautiously given the small and highly selected cohort, but suggest that SLIC 2 may remain an option in selected patients with reducible chronic static scapholunate dissociation.

LEVEL OF EVIDENCE: IV.