Background: Scapholunate ligament injury is rare in the adolescent
and pediatric population, and the results of treatment have not been well
described. The purpose of the present study was to review the outcomes of
arthroscopic management of patients with persistent wrist pain and
scapholunate ligament injury as documented on arthroscopic examination who had
had a failure of at least six months of nonoperative management.
Methods: The medical records of thirty-two pediatric and adolescent
patients who underwent arthroscopic treatment of scapholunate ligament
injuries were retrospectively reviewed to obtain preoperative and
postoperative modified Mayo wrist scores, radiographic data, and
intraoperative findings, including the classifications of interosseous
ligament injury, chondral injury, and other abnormalities. Patients were
contacted after a minimum of two years of follow-up for reevaluation of the
Mayo wrist scores.
Results: Arthroscopic evaluation revealed thirty Geissler type-II
tears and two Geissler type-III tears. In addition to these scapholunate
ligament injuries, seven of the thirty-two patients had partial tears of the
short radiolunate ligament that appeared to be at the site of impaction from
carpal subluxation, twelve had a triangular fibrocartilage complex injury, and
twenty-seven had a chondral injury. The modified Mayo wrist scores showed
improvement following arthroscopic débridement of partial-thickness
tears and associated chondral injuries. The average wrist score was 66.3
preoperatively and 91.6 at an average of forty-three months of follow-up.
Eight patients required subsequent surgery because of deterioration in their
clinical status. After a mean duration of follow-up of 30.8 months, the
average wrist score was 87.1.
Conclusions: The majority of pediatric and adolescent patients with
wrist pain who have a failure of nonoperative management and who have a
Geissler type-II scapholunate ligament tear on arthroscopic examination can
have substantial long-term improvement following arthroscopic
débridement of the tear combined with treatment of other associated
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.