PURPOSE: Chronic scapholunate interosseous ligament injuries contribute significantly to wrist instability. Surgical management remains challenging, with tendon graft-based reconstruction and dorsal capsulodesis being the most common techniques. This systematic review aimed to compare the clinical and radiographic outcomes of capsulodesis-based versus tendon graft techniques for chronic scapholunate ligament injuries.
METHODS: This systematic review was conducted per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search of PubMed, Web of Science, Scopus, and Cochrane Library identified eligible comparative studies. Studies comparing tendon graft techniques and dorsal capsulodesis for chronic scapholunate interosseous ligament injuries in adults were included. The Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool was used for quality assessment. Because of data heterogeneity and lack of consistent quantitative metrics (eg, means and standard deviations), a narrative synthesis of results was performed.
RESULTS: Across six included studies encompassing 298 patients, tendon graft and tenodesis techniques demonstrated variable postoperative outcomes. Notable heterogeneity existed within the tendon graft/tenodesis category itself: modified Brunelli tenodesis outperformed the four-bone weave in pain relief (visual analog scale reduction 4.8 cm vs 3.2 cm), grip strength, range of motion (ROM) preservation (86% vs 60%), and Disabilities of the Arm, Shoulder, and Hand (DASH) score improvement (31.5 vs 14.2 points). Scapholunate intercarpal ligament similarly outperformed three-ligament tenodesis across grip strength, ROM (113° vs 82°), and patient-reported outcomes. Dorsal capsulodesis provided consistent pain relief, adequate ROM preservation, and lower surgical failure rates in most series, with no statistically significant differences in patient-reported outcome measures compared to tenodesis groups. Radiographic deterioration was observed across all surgical techniques over long-term follow-up without consistent correlation with clinical symptoms. Overall certainty of evidence was very low per Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment.
CONCLUSIONS: Neither tendon graft nor capsulodesis techniques demonstrated consistent superiority; outcome differences were more pronounced within technique subcategories than between groups, highlighting the need for standardized, high-quality prospective trials.
CLINICAL RELEVANCE: Tendon graft reconstruction and dorsal capsulodesis show comparable outcomes for chronic scapholunate ligament injury. Surgical choice should be individualized based on patient factors, injury characteristics, and surgeon expertise. Given the very low certainty of current evidence, standardized outcome reporting and further high-quality prospective studies are needed.
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