Scapholunate Ligament Injuries

The scapholunate ligament  (SLL) is a short, stout important ligament between the scaphoid and lunate bones. It has an important dynamic function linking the 2 rows of carpal bones.

It is not infrequently injured after falls, sports injuries, higher energy injuries (motorcycle accidents). The patient clinically presents with central wrist pain and swelling and pain is particularly bad on loading the wrist (eg press up). The initial XRs can be unremarkable. With acute complete SLL ruptures, XRs may show a gap or diastasis between the scapholunate interface or an increase in the scapholunate angle with the lunate extended.

The diagnosis can be confirmed on MRI imaging or at wrist IMG_2722arthroscopy. there are different grades of SLL injury and sometimes the ligament is merely stretched but remains in continuoity. This can nonetheless be symptomatic but early surgery is not indicated and a trial of non-operative treatment is usually advised.

Complete SLL ruptures are more problematic and if diagnosed very early (within 6 weeks) then direct repair is possible. If as is usually the case, the diagnosis is made later then the patient is probably looking at reconstruction.


SLL Reconstruction (Brunelli)-for chronic SLL ruptures

Several procedures have been described to address this problem . None are perfect.  My preferred choice is the Brunelli procedure whereby a strip of tendon is harvested from the front of the wrist and passed through the scaphoid (pre-drilled) to the back of the wrist and then tensioned over dorsal ligaments and secured/transfixed onto the lunate. The aim is to reproduce the function of the SLL. The main drawback with the Brunelli procedure is that most patients will lose some range of movement.

If left untreated then there is a risk of premature arthritis in the wrist which might necessitate salvage procedures at a later date.