Scapholunate Ligament Repair CPT
Scapholunate Ligament Repair Anatomy
Scapholunate Ligament Repair Indications
- Acute scapholunate instability
- Subacute scapholunate instability
Scapholunate Ligament Repair Contraindications
- Radioscaphoid arthritis
- Capitolunate arthritis
- Chronic scapholunate instability
Scapholunate Ligament Repair Alternatives
Scapholunate Ligament Repair Pre-op Planning / Special Considerations
Scapholunate Ligament Repair Technique
- Pre-op antibiotics.
- Supine position with hand table.
- Anesthesia (regional or general)
- EUA compare to uninjured side.
- Touniquet high on arm.
- Consider Wrist Arthroscopy to confirm diagnosis and examine for arthritic changes.
- Dorsal longitudinal incision just ulnar to Lister's Tubercle.
- Step-cut insicion in the extenosr retinacular over the 4th dorsal compartment.
- Consider posterior interosseous nerve neurectomy.
- Transverse incision in capsule just proximal to the dorsal intercarpal ligament. Extend the incision proximally and radially along the radial aspect of the radiocarpal ligament as needed.
- Indentify the scapholunate interosseous ligament. It is typically avulsed from its scaphoid insertion.
- Evaluate the dorsal intercarpal ligament for injury to its lunate of scaphoid insertions.
- Evaluate for any chondral injury.
- Reduce scapholunate joint anatomically. The scaphoid is typically flexed and the lunate is typically extended. K-wires may be needed to aid in the reduction.
- Place 1or 2 0.045 k-wires from radial to ulnar across the scapholunate joint and 1 -.045 K-wires from ulnar to radial across the triquetrolunate joint to maintain the reduction.
- Place mini-suture anchors (2.0-3.0mm) to anatomically restore the scapholunate interosseous ligament and dorsal intercarpal ligament.
- Repair the capsule and extensor retinaculum.
- Repair in layers.
Scapholunate Ligament Repair Complications
- Loss of reduction
- Pin track infection
Scapholunate Ligament Repair Follow-up care
- Long-arm splint in pronation for 4-6 weeks, with frequent follow-up xrays to assess reduction.
- At 6 week follow-up change to short-arm splint.
- K-wires are removed at 10-12weeks.
- Consider occupational therapy if stiffness continues one month after pin removal.
Scapholunate Ligament Repair Outcomes
Scapholunate Ligament Repair Review References