Chronic, Reducible Scapholunate Ligament Injury: Arthroscopic Box Reconstruction

A 39-year-old gentleman presented with a 9-week-old scapholunate ligament injury of the left wrist with scapholunate dissociation which had been operated previously. The dissociation and DISI deformity were not reducible initially. Arthroscopic arthrolysis at eleventh week helped to remove the intervening scar tissue and fibrotic contracture of capsular structures to render the dissociation reducible. This was followed by an arthroscopic-assisted dorsal-volar box reconstruction of the scapholunate ligament complex using a free palmaris longus tendon graft passing through bone tunnels created at the proximal scaphoid and lunate under fluoroscopic and arthroscopic control, avoiding the need for extensive dissection of the wrist joint. The reduction was satisfactory and stable. No pin fixation was needed. Mobilization of the wrist commenced at ninth week and the patient resumed sport activities at 6 months. At final follow-up by 4 years 10 months post-operation, the patient had no pain and excellent wrist function.