Surgical management in chronic scapholunate ligament injury without arthritic change

Abstract

Scapholunate (SL) ligament injury represents the most common form of carpal instability and typically occurs following a fall onto an outstretched hand. Patients often present with dorsoradial wrist pain, swelling, or mechanical symptoms such as clicking on the affected side. Despite its prevalence, diagnosis in the acute phase can be challenging due to the nonspecific nature of early clinical findings and the frequently inconclusive appearance of initial radiographs. Although outpatient wrist arthroscopy may facilitate early diagnosis and treatment, its availability is generally limited to tertiary care centers. Delayed or missed diagnosis may lead to chronic wrist pain, progressive instability, and long-term functional impairment.

Several classification systems have been proposed for SL ligament injuries. This review focuses on static, reducible scapholunate ligament injuries without radiographic evidence of degenerative changes. According to contemporary practical management guidelines, these injuries correspond to stages III through V of the modified Garcia-Elias classification, reflecting increasing severity of ligamentous and capsuloligamentous disruption. These types of injuries are commonly encountered in patients whose symptoms have persisted for more than six weeks, representing the chronic phase of scapholunate ligament injury.

Surgical reconstruction remains the cornerstone of management for these lesions. However, no single operative technique has been universally accepted as the standard of care. The objective of this review is to synthesize the most current evidence and provide an educational summary of the available surgical options for treating static, reducible SL ligament injuries, with particular attention to reported clinical outcomes associated with each technique.