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Master Thesis

Ligamentoplasties dans l’instabilité scapho-lunaire : résultats à court terme de la technique “All dorsal scapholunate repair”

Abstract : Introduction: Scapholunate instability is the most frequent carpal instability. Lesions of the scapholunate ligament and secondary stabilizers lead to biomechanic modifications of the carpus. Without any care, the instability will lead to wrist arthritis called SLAC wrist. The surgery aims to correct the misalignment of the carpus before the apparition of secondary lesions. Current techniques fail in obtaining satisfactory results. For this reason, there is no consensus about the best method to treat this injury. The study aims to report the results of a recent technique of ligamentoplasty called « all dorsal scapholunate repair » using the concept of internal brace with a synthetic ribbon. Materials and methods: This retrospective study gathers the results of 21 patients. With an average age of 44 years old, all patients present a scapholunate instability stage 3 or 4 of the Garcia Elias classification. They all have been treated with the ligamentoplasty « all dorsal scapholunate repair ». Clinical, functional et radiological outcomes have been evaluated. Results: The average follow up time was 14,2 months. Ninety-five percent of the patients were experiencing pain during exercise (4/10) and only 14% at rest (0,1/10). The grip strength was limited to 65% compared to the opposite side. Arc of mobility in flexion-extension was 105° with, on average, flexion at 68% of the flexion of the opposite side, extension at 80%, ulnar and radial deviation at 82 and 77% respectively. There was a statistically significant reduction of the scapholunate angle and the scapholunate gap. The average QuickDASH was 29,2, PRWE 24, Mayo Wrist Score 67,8 with 5 excellent results, 4 good, 4 fair and 7 poor. The satisfaction score was on average at 3,1 on 4 with 81% of the patients considered satisfied or very satisfied. Sixty six percent of patients have returned to work in 5,2 months and 4 patients were considered disabled. Seventy nine percent of the population have returned to sport in 4 months. In the event of work related accident, functional scores were less good associated with a delayed return to work. The number of pins did not affect the results. Over a year of follow up, pain while exercising significantly decreased. Improvement in wrist mobility and functional scores were also observed. There was no statistically significant difference of the scapholunate angle or the scapholunate gap with time. Forty seven percent of patients were presenting an osteolysis zone around the anchor’s implantation site. Discussion: The ligamentoplasty « all dorsal scapholunate repair » allows obtaining good short-term clinical and functional outcomes, except for the Mayo Wrist Score and the grip strength. Most of the cohort is satisfied. The reduction of the radiological outcomes seems to be stable in time despite the persistence of a scapholunate gap. Based on the results, only one protective pin can be enough, its presence can also be discussed. The work relative accident is a poorer functional and socio-economic pronostic factor. The increase of the follow up time shows improvement in pain, functional scores and mobility. It should be interesting to realize a long terme comparative study with a larger cohort. The evolution of the osteolysis zones needs to be carefully controlled.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03364501
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Submitted on : Monday, October 4, 2021 - 5:10:52 PM
Last modification on : Wednesday, October 6, 2021 - 3:25:40 AM

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  • HAL Id : dumas-03364501, version 1

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Laura Helfter. Ligamentoplasties dans l’instabilité scapho-lunaire : résultats à court terme de la technique “All dorsal scapholunate repair”. Médecine humaine et pathologie. 2021. ⟨dumas-03364501⟩

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