A Biomechanical Evaluation of the ECRL Tenodesis for Reconstruction of the Scapholunate Ligament.

Autor:	Chan AHW; Divisions of Plastics and Orthopaedic Surgery, Toronto Western Hospital Hand Clinic, University Health Network, University of Toronto, Toronto, Ontario, Canada., Padmore CE; Department of Biomedical Engineering, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada., Langhor DG; Department of Mechanical and Materials Engineering, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada., Grewal R; Division of Orthopaedic Surgery, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada., Johnson JA; Department of Mechanical and Materials Engineering, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada., Suh N; Division of Orthopaedic Surgery, Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada. Electronic address: nina.suh@sjhc.london.on.ca.
Jazyk:	angličtina
Zdroj:	The Journal of hand surgery [J Hand Surg Am] 2021 Mar; Vol. 46 (3), pp. 244.e1-244.e11. Date of Electronic Publication: 2020 Nov 06.
DOI:	10.1016/j.jhsa.2020.08.021
Abstrakt:	Purpose: Reconstruction of the scapholunate ligament (SLL) in the setting of dynamic instability remains a surgical challenge, with lack of consensus on the best reconstructive procedure. Reconstruction of only the dorsal component may lead to volar gapping and abnormal wrist kinematics. This cadaveric active motion simulation study determined whether scapholunate (SL) motion, angulation, and contact are restored following open reconstruction using the extensor carpi radialis longus (ECRL) tenodesis, which reconstructs both the volar and the dorsal SLL components. Methods: Seven fresh-frozen cadaveric upper limbs (mean age, 68 ± 10.1 years) underwent a 4-stage protocol of cyclic dart-throw motion and flexion-extension motion (utilizing an active wrist motion simulator that used tendon load/motion-controlled actuation. Scaphoid and lunate motion, relative scaphoid translation, SL angle, and dorsal-volar SL diastasis were measured with (1) wrist ligaments intact, (2) following complete sectioning of the SLL, and (3) following SL reconstruction using the ECRL tenodesis technique. Results: Complete SLL sectioning resulted in a typical pattern of SL instability. Following the ECRL tenodesis, lunate extension was not corrected. Scaphoid flexion, however, was not significantly different from the native state in FEM but remained significantly flexed during dart-throw motion. Differential dorsal and volar gapping did not significantly improve following ECRL tenodesis (dorsal, 1.2-2.3 mm; volar, 1.1-1.7 mm). Conclusions: This biomechanical study demonstrates that the ECRL tenodesis did not fully restore native carpal kinematics, despite dorsal and volar SLL, and scaphotrapeziotrapezoid reconstruction. Type of Study/level of Evidence: Therapeutic IV. (Copyright © 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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