Outcomes of Internal Brace Augmentation for Scapholunate Ligament Surgery: A Case Series with Minimum 3-Year Follow-up

Abstract

Scapholunate ligament (SL) injuries remain a difficult pathology to treat, both in the acute and chronic settings. An evolving technique has been the use of the internal brace (IB) to augment dorsal SL repairs. We evaluated our experience with this technique in both isolated SL injuries and those with concurrent perilunate (PL) injuries.

Following institutional review board approval, a retrospective chart review was performed for patients who underwent SL repair or reconstruction with IB augmentation from 2019 to 2021 at our institution. Patients were divided into two cohorts: those with isolated SL injuries (standard IB) and those with concomitant PL pathology (PL/IB). Patients were contacted prospectively for patient-reported outcome measures (PROMs) and wrist range of motion (ROM).

A total of 14 patients were included in this study (standard IB: n = 10 and PL/IB: n = 4) with mean follow-up of 46.9 months. There were no significant differences in postoperative ROM or PROMs between the standard IB and PL/IB cohorts. While postoperative Visual Analogue Scale pain and wrist subjective value demonstrated improvement from preoperative values, postoperative ROM either improved minimally or worsened between groups. Globally, there was low satisfaction with surgical intervention. Patients with isolated SL injuries were not highly satisfied, and a majority said they would undergo a revision if available. Patients with concomitant SL and PL injuries reported slightly better functional and subjective outcomes, although individuals also expressed minimal satisfaction and interest in a different revision option if available.

Utilization of the IB system to augment SL repairs leads to variable outcomes at short-term follow-up. Although patients with concomitant PL injuries fared slightly better, patients overall had low rates of surgical satisfaction. Half of our cohort would not undergo surgery again, and 86% were interested in a better surgical option. This study illustrates the complexity and challenges when treating patients with SL injuries, highlighting the need for further investigation to better elucidate surgical algorithms.

2b—individual cohort study.