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

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

This animated video provides a demonstration of a scapholunate ligament repair utilizing an internal support suture along with a tendon graft. A surgical incision will be made on top of the wrist directly over the damaged ligament, which is between the scaphoid and the lunate wrist bones.

A portion of the nearby tendon, called the extensor carpi radialis brevis or E C R B, will be trimmed for the graft. The tendon graft will be stitched at its end with a strong, supportive suture loop that will be used later in the repair.

Two temporary wires will be placed in the scaphoid and lunate bones. This is to help position the bones in their proper alignment, as shown here. A surgical clamp will hold the wires and bones in place during the surgery.

Three additional temporary wires will be placed, 1 in the lunate and 2 in both ends of the scaphoid. All 3 recently placed wires will be drilled over to create a hole in the bone for the incoming anchor that will be used to hold the internal support suture and tendon in the bone. The wires will then be removed.

The end of the tendon graft and the blue and white support suture will be placed in the end of the forked bone anchor. This will then be inserted into the inner hole of the scaphoid, with a specific blue instrument that will screw the anchor into the bone. One end of the support suture will be cut.

Once inserted, the remaining tendon graft and support suture will be laid flat over the joint and the hole in the lunate bone. A second bone anchor will capture the tendon and support suture, and both will be secured in the bone.

Then, the remaining tendon graft and suture will be twisted together and brought over to the final hole in the scaphoid. Again, a bone anchor will capture the tendon graft and support suture and will be secured in the bone. The remaining graft and support suture will be cut.

A temporary wire will be placed in the scaphoid and a nearby wrist bone, called the capitate, to hold the repair in place while it heals. This wire will later be removed in the doctor's office. The other wires can be removed now. The incision is closed, and the surgery is complete.