Outcomes of Acute versus Subacute Scapholunate Ligament Repair

Hypothesis: It is currently unknown whether time from injury affects outcomes following repair of dorsal scapholunate ligament (SLL) tears. We tested the null hypothesis that the outcomes of SLL repair are similar when performed within 6 weeks of injury (acute repair) versus when repaired from 6 to 12 weeks following injury (subacute repair). Methods: This case-control study examined 22 patients (12 acute repair, 10 sub-acute repair) who underwent dorsal SLL repair for isolated complete tears of the SLL, with or without supplementary capsulodesis. Patients who underwent SLL repair for complete rupture of the dorsal SLL between 1996 and 2012 were identified from an electronic billing database. Demographic data (age, sex, BMI, occupation, tobacco use) was recorded and radiographic measurements (SL angle and SL gap) were determined from preoperative radiographs. All patients returned to clinic for a study-related visit including radiographic examination of the injured wrist (PA, lateral, supinated PA grip view), physical examination (wrist range of motion, strength testing) and standardized questionnaires (Michigan Hand Questionnaire, VAS-function and pain, SF-12). Analyses were performed on all categorical and continuous data to compare acute and subacute repair groups (P < 0.05). Results: The median length of follow-up for the acute and sub-acute groups were 5.5 and 6.1 years, respectively (Table 1). There was no significant difference in any of the variables between the two groups. The groups were near identical with regard to final SL angle (acute: 66 , subacute: 65 ), final SL gap (3.0 mm, 2.9 mm), and proportion of cases that progressed to scapholunate-advanced collapse (2/12, 2/10). Patient-rated outcomes were not different between patient groups (Table 2). Wrist motion (P 1⁄4 0.20) and forearm motion (P 1⁄4 0.21) were also comparable for the acute and subacute repairs. Both acute and subacute repairs demonstrated well-preserved grip strength (98% of unaffected versus 90%) (P 1⁄4 0.29). Summary Points: At a median follow-up of 5.5 and 6.1 years, respectively, no statistically significant or clinically relevant differences were found when comparing radiographic findings, patient rated outcomes and wrist motion following acute and subacute SLL repair. Acute and subacute repairs of the SLL demonstrate similar rates of progression to end-stage arthritis. Whether treated within 6 weeks or 12 weeks of injury, SLL repair may produce a similar outcome when reparable ligamentous tissue exists. REFERENCES