Antipronation Spiral Tenodesis for the Treatment of Chronic Reducible Scapholunate Instability with Associated Radiolunate or Perilunate Instability

Background. After a significant wrist trauma different degree of scapholunate ligament (SLL) injuries may occur. As the wrist is constantly receiving loads, SLL injuries may evolve with time. Accordingly, seven stages of SLL pathology have been described. The term scapholunate dysfunction (SLD) has been proposed to define any of the seven stages within the wide spectrum of SLL pathology, and different treatments have been suggested to apply to each stage. Therefore, staging should be the first step in SLD management. Likewise, inability to recognize SLD stage has been related to treatment failure. Objective. A case of a 39-year-old male who suffers from SLL injury is presented to illustrate a guide to SLD management. The diagnostic workup, the treatment decision and the surgical technique chosen to treat a case of Stage 5 SLD are described. Clinical relevance: (1) Identification of SLD stage is paramount before designing a treatment plan, and intraoperative confirmation is recommended before definitive treatment execution. (2) In cases with a chronic complete rupture of SLL where the radiolunate joint is unstable, the malalignment is reducible and there is no cartilage damage (Stage 5 of SLD), isolated scapholunate joint (SLj) tendon reconstruction techniques are prone to fail. The Antipronation Spiral Tenodesis (AST) has been designed to realign the scaphoid and reconstruct the SL, the dorsal lunotriquetral (dLTr) and the palmar radiolunotriquetral ligaments to correct ulnar translocation of the lunate.