Wrist Instability (Scapholunate Ligament Injuries): Anatomic C Scapholunate Ligament Reconstruction With Suture Augmentation

Wrist Instability (Scapholunate Ligament Injuries): Anatomic C Scapholunate Ligament Reconstruction With Suture Augmentation

This cadaveric surgical video will demonstrate the treatment of a scapholunate ligament injury, utilizing the anatomic C reconstruction technique with internal support suture and bone anchors. The scapholunate ligament is a C-shaped structure. It lies between the wrist's scaphoid and lunate carpal bones. If the ligament is damaged and the space between the 2 bones widens, instability may occur in the wrist.

This widening and instability can be managed using the anatomic C procedure. Here is a right hand. The surgeon will begin by making an incision over the top of the wrist and extending it deeper until the joint is reached. The hand will be placed on a surgical towel to flex the wrist, providing easier viewing and access to the scapholunate joint. A surgical retractor will be used to hold open the soft tissues.

The surgeon then identifies the widened space between the 2 bones, representing an injury to the scapholunate ligament. A temporary wire will be placed in the scaphoid and 1 in the lunate to act as joysticks to manipulate the bones into position. Two surgical pen marks will be made to mark the location for the incoming bone anchors. Another temporary wire will be placed in the marking on top of the lunate bone.

A drill will be introduced over the wire, and a hole will be made. The same process will be repeated on the top of the scaphoid, then the side of the scaphoid, and the side of the lunate. There are now a total of 4 holes. The hole at the top of the scaphoid will be over-drilled to make a larger diameter hole for 1 of the anchors, which will eventually hold 2 limbs of the suture.

Then, the bone anchor, with the attached support suture, will be placed into the first hole, on top of the lunate, and screwed in place. One limb of the support suture will be captured by a fork-tipped bone anchor and secured into the hole in the side of the scaphoid. Once captured in the bone, the support suture will then be brought over to the hole in the side of the lunate bone and, again, captured and screwed into place with a fork-tipped anchor.

Finally, the support suture end will be brought over the final hole on top of the scaphoid and met with the other limb of the suture brought over from the hole on top of the lunate. The final procedure demonstrates the support of 2 parallel suture limbs and 2 limbs forming an X across the 2 bones, which will help control widening and the rotational instability of the injured ligament. The suture is taut and secure. The ends of the 2 suture limbs will be trimmed. The incision will be closed, and the surgery is now complete.