Role of Ligament Stabilizers of the Proximal Carpal Row in Preventing Dorsal Intercalated Segment Instability

Abstract

BACKGROUND: Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability. METHODS: Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DIC) and scaphoid insertion (DIC) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline. RESULTS: Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DIC significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DIC+DIC produced dorsal intercalated segment instability. CONCLUSIONS: In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DIC+DIC). CLINICAL RELEVANCE: When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered.