Journal of Hand Surgery European - 2026-03-11 - Journal Article
Functional and radiological outcomes of the all-dorsal technique for scapholunate ligament reconstruction.
Nguyen CT, Hohenstein AA, Osterloh J, Zajonc H, Eisenhardt SU, Leibig N
Topics
Key Takeaway
The all-dorsal ECRB tendon autograft technique for chronic scapholunate reconstruction yielded non-significant improvements in pain (VAS 5→2) and DASH (58→48) at mean 39 months, with persistent radiographic malalignment (median SL angle 66°, static gap 3 mm) and a 42% anchor-site osteolysis rate.
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Summary
This retrospective study evaluated functional and radiographic outcomes of the all-dorsal ECRB autograft scapholunate reconstruction in 31 patients with chronic SL rupture at mean 39-month follow-up. Pain and DASH scores improved but did not reach statistical significance, grip strength was essentially unchanged (28→29 kg), and radiographic carpal alignment remained abnormal in all measured parameters. Five patients (16%) required salvage procedures for progressive osteoarthritis, and anchor-site osteolysis occurred in 13 patients (42%).
Key Limitation
The absence of a comparator group and small heterogeneous cohort (12–84 month follow-up range) make it impossible to determine whether outcomes differ meaningfully from other reconstruction strategies or natural history.
Original Abstract
INTRODUCTION
Scapholunate instability is a common and challenging wrist pathology with no universally accepted surgical solution. The all-dorsal scapholunate reconstruction technique restores the dorsal ligament with an extensor carpi radialis brevis tendon autograft. The aim of this study was to assess outcomes in patients with a chronic scapholunate ligament rupture.
METHODS
We retrospectively analysed 31 patients. Outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score and a visual analogue scale score for pain. Clinical examination included wrist range of motion and grip strength. The radiological parameters measured were scapholunate (SL) angle and gap. Follow-up averaged 39 months (range 12-84) for all outcomes.
RESULTS
Postoperatively median pain scores improved from 5 to 2 and disability scores from 58 to 48, although changes were not statistically significant. Median wrist extension at final follow-up measured 50° (IQR 42.5 to 70) and flexion 45° (IQR 39 to 60). Radiographically, there was persistent carpal malalignment with a median SL angle of 66° (IQR 58 to 73), a static SL gap of 3 mm (IQR 2.2 to 4) and a dynamic SL gap of 4.8 mm (IQR 3.3 to 5.4). Median grip strength improved from 28 kg (IQR 20 to 40) preoperatively to 29 kg (20-37) postoperatively. Five patients required salvage procedures owing to progressive symptomatic osteoarthritis. Complications included complex regional pain syndrome ( n = 3), transient nerve symptoms ( n = 2), anchor-site osteolysis ( n = 13) and isolated scaphocapitate joint osteoarthritis ( n = 5).
CONCLUSION
The relative simplicity and preservation of wrist function with the all-dorsal reconstruction technique justify its continued use, despite high complication and revision incidences.
LEVEL OF EVIDENCE
Level IV.