Wide Awake Scapholunate ligament reconstruction

Abstract

Background: The Dorsal Internal Brace reconstruction is designed to treat scapholunate ligament (SLL) instability. Wide awake surgery without a tourniquet allows the movement of the bones and thus the instability of the carpal bones to be actively visualized during surgery. Hypothesis: The aim of this prospective study is to analyze the feasibility of the Wide Awake Procedure (Walant) for this surgical technique, to assess the stability of the SLL in active motion and then to allow for an early rehabilitation protocol. Material: From January 2021 to December 2022, 6 adult patients with scapholunate instability stage 3 or 4 according to the Garcia Elias classification were included. Operating under Walant allowed the surgeon to confirm the dynamic instability in active movement per operation and at the end of the procedure to confirm the solidity of the suture without bone impingement. A splint was applied for 3 weeks and then the patients were asked to start rehabilitation. Results: Osteoporosis in a 60-year-old woman led to failure of the anchor implant. Reconstruction was successful in the other 5 patients. The QuickDASH score decreased from 34 to 9/100. Clinical and radiological examination (X-ray and ultrasound) before surgery and at 6 weeks, 3 months and 6 months postoperatively showed a continued good result. Discussion: This preliminary observational report is the first to investigate the feasibility of Walant for SLL repair. We conclude that this technique of anesthesia should be suggested to surgeons to evaluate SLL instability and its treatment. Level of evidence: IV.

Keywords

• Carpal
• Walant
• Internal brace
• Instability
• Scapholunate
• Wrist