Ho's technique: A boon for patients with scapholunate instability - A case series

The scapho-lunate joint is stabilised by the dorsal and the volar portion of the scapholunate interosseous ligament and extrinsic carpal ligaments. The presence of SL dissociation spells downhill course for the wrist. Early recognition and appropriate treatment has excellent outcomes.

We had a case series of 10 patients of SL instability, with 7 of them having Geissler stage 3 and 3 of them in stage 4 dissociation . The average preoperative SL interval was 4.9 mm. Dorsal intercalated segment instability deformity was present in 3 patients.1 patient had stage 1 SLAC wrist change radiologically. We did Arthroscopy assisted evaluation of the SL interval, arthroscopic debridement and reduction of SL joint with reconstruction of the dorsal and palmar SL ligaments anatomically using palmaris longus graft in a boxlike structure without violating joint capsule and knotted on the dorsal surface of SL joint extracapsularly in a shoe-lacing manner. Scapholunate and scaphocapitate joints were transfixed with K-wire for 6–8 weeks. This method described by PC Ho addressed volar constraints and did not fail to reduce SL gapping

On follow-ups, all returned to their preinjury job level. Eight patients had no wrist pain, and 2 had some pain on maximum exertion. The postoperative PRWE score had a mean improvement of 55%. Average extension range improved by 14%, flexion by 18%, radial deviation by 15%, and ulnar deviation by 27%.Mean grip strength was 120% of the preoperative status and 84% of the contralateral. The average SL interval was 2.8 mm

This minimally invasive method is a logical and effective technique to improve SL stability. Risk of ischemic necrosis of the carpal bone is minimized by preservation of the scaphoid blood supply, the small size of the bone tunnels, and the inclusion of the capsule at the reconstruction site

Keywords: SL dissociation, Arthroscopic reconstruction