Capsulodesis with Internal Brace Augmentation for Treatment of Static Scapholunate Instability

Scapholunate instability represents a spectrum of injuries that ranges from dynamic to static instability. Mechanism of injury, degree of ligamentous disruption, and chronicity of injury may play into whether a patient has a reducible or fixed deformity. Because of this variability, scapholunate injuries can be difficult for providers to treat. Numerous methods of treatment for static scapholunate instability have been proposed, but no strategy has proven to be superior. In this chapter, we propose a novel method of treatment: Capsulodesis with Internal Brace Augmentation (CIBA). This technique utilizes the internal brace concept and maximizes biomechanical stability through an all-dorsal approach for scapholunate ligament reconstruction. We review preoperative planning, indications for CIBA, surgical technique, technique rationale, pearls and pitfalls, and complications of treatment of scapholunate instability. As more outcomes data is reported in the literature, we believe that this technique holds promise and may play a larger role in treating these difficult injuries in the future.