Chronic, Reducible Scapholunate Ligament Injury: ANAFAB

The optimum intervention to restore function after scapholunate ligament injury remains controversial. As part of normal carpal mechanics, there are composite dorsal and volar ligaments that work together to maintain carpal stability and function—and a therapeutic intervention to address the spectrum of injury should aim to the restore normal anatomy. The dorsal extrinsic ligaments (DIC, DCSS, DRC) have become increasingly identified as critical to carpal stability, and where these structures are the predominant region of injury, a localized repair to the dorsal structures in lesser degrees of injury is appropriate. Where the extent of disruption implies volar damage as well, a volar and dorsal anatomical restoration is required. The ANAFAB (Anatomical Front and Back) technique addresses both volar and dorsal disruption, restoring the native ligamentous restraints, and is indicated for higher grades of scapholunate ligament injury where a dorsal repair alone may be inadequate to address the extent of ligamentous disruption in an anatomically restorative fashion.