Scapholunate ligament repair/reconstruction

The scapholunate ligament is a ‘C’ shaped ligament that connects the scaphoid bone in the wrist to the lunate bone. It is a crucial stabiliser of the wrist. Scapholunate ligament injuries occur most commonly from high impact injuries on a hyperextended wrist such as falling on an outstretched hand, falls from heights or in motorcycle accidents. Injuries to the scapholunate ligament are the most frequent cause of carpal instability in the wrist.

 

During the operation, an incision will be made on the dorsal wrist. Following the surgery, but still during the procedure, a forearm-based plaster backslab will be applied. The incision will be closed with sutures and be protected by a waterproof dressing and the arm will be in a sling.

 

The following is an example of a scapholunate ligament reconstruction. The reconstruction could utilize either parts of a patient’s tendon, or synthetic ligament, or a combination of both.

Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

Given the importance of the scapholunate ligament to wrist stability, it is vital it be protected during the healing process. Keep all dressings/bandages intact and dry until the first post-operative appointment with Kemble or a hand therapist. A plastic bag tied above the elbow to prevent the arm from getting wet can be used during showering, or alternatively a one-handed bath can be taken. Kemble will review the wound and advise it is able to get wet.

 

0-2 weeks after surgery

  • Arm must be kept elevated at all times. This is particularly important in the first 5-7 days post-surgery. This helps to reduce swelling. A pillow can be used to prop-up the arm when seated or lying down; 

  • Finger movement should begin early and regularly and unaffected joints – such as shoulder and elbow – should also continue to be moved to avoid stiffness.

Weeks 2-4 post surgery:

  • Cast to be removed 10-14 days post-operation;

  • A thermoplastic splint to be fabricated by a hand therapist;

  • Splint to continue full-time except for hygiene reasons and when exercising;

  • Wound to be checked, dressing changed, and sutures removed as necessary;

  • Safe to begin a ‘dart thrower’s’ motion as well as active rotation exercises prescribed by a hand therapist which do not stress the repair;

  • Some pain is normal and patients should be encouraged to continue to try and move the wrists;. 

  • Begin scar massage;

  • Light functional tasks with the hand in a splint- such as eating, dressing and using a phone – should commence.

 

Weeks 6 post surgery:

  • Rehabilitation exercises to be upgraded to full wrist range exercises, active and passive;

  • Ligament retraining exercises prescribed to improve wrist function;

  • Continue to avoid weight bearing activities.

Weeks 8 post surgery:

  • Strength and ligament retraining exercises to continue and possibly be upgraded;

  • Weight bearing exercises to commence.

Return to activity

  • The speed of healing and a return to sport timetable differs for every patient.  However, this generally does not occur before 12 weeks post-operation and only with a therapist’s input.

Possible complications of this injury/procedure

  • Ligament not healing adequately;

  • Ligament re-tearing despite initial healing;

  • Ongoing instability and secondary arthritic changes.

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for specific advice from either Kemble Wang or your other healthcare practitioners