Arthritis Development Following Untreated Scapholunate Instability of the Wrist

Abstract

PURPOSE OF THE STUDY Complete disruption of the scapholunate (SL) ligament results in the development of arthritic lesions known as scapholunate advanced collapse (SLAC) of the wrist. MATERIAL AND METHODS The authors present the results of a prospective study of seven patients in whom radiography showed an acute com- plete rupture of the scapholunate ligament and who refused SL ligament reconstruction.This group (1) was compared with a group of 17 patients (2) who underwent ligament reconstruction soon? after an acute rupture had been detected. All patients were examined at 36 months after injury for hand function and pain using the Wrightington Hospital Wrist Scoring (WHWS) System, and for the presence or absence of SLAC by radiography. Group 1 patients underwent arthroscopic examination in order to evaluate the extent of arthritic lesions. RESULTS As assessed by the WHWS system, in group 1 excellent, good and satisfactory results were achieved in 29%, 42% and 29% of the patients, respectively in group 2 these results were found in 59%, 35% and 6% of the patients. The radiography showed, in group 1, 14% patients free from SLAC, 43% with stage I SLAC, 29% with stage IIa SLAC and 14% with stage IIb SLAC. In group 2, 94% of the patients were free from signs of SLAC and 6% had stage IIa SLAC due to infectious complications. The arthroscopic evaluation of group 1 revealed SLAC signs in all ;patients as follows: stage I, 29% stage IIa, 42% and stage IIb, 29%. CONCLUSIONS In patients with complete disruption of the SL ligament there is a rapid onset of arthritic lesions in the wrist detectable by radiography. Arthroscopic examination, however, shows a much higher extent of damage to cartilage of the wrist. Key words: wrist arthritis, scapholunal instability, arthroscopy of the wrist.