Results of tri-ligament tenodesis: a modified brunelli procedure in the management of scapholunate instability

• Published in: Journal of hand surgery, British volume British volume, 2006-02, Vol.31 (1), p.110-117
• Main Authors: Talwalkar, S.C., Edwards, A.T.J., Hayton, M.J., Stilwell, John H., Trail, I.A., Stanley, J.K.
• Format: Article
• Language: English
• Subjects: Adult; carpal instability; Carpal Joints - surgery; dynamic; Female; Follow-Up Studies; Hand Strength; Humans; Joint Instability - surgery; Ligaments, Articular - surgery; Lunate Bone - surgery; Male; Middle Aged; Pain Measurement; Patient Satisfaction; Range of Motion, Articular; Scaphoid Bone - surgery; scapholunate dissociation; static; Surveys and Questionnaires; Tendon Transfer - methods; Tendons - surgery; tenodesis; Treatment Outcome
• ISSN: 0266-7681; 1532-2211
• DOI: 10.1016/j.jhsb.2005.09.016

One hundred and sixty-two patients with a diagnosis of scapholunate instability underwent a modified Brunelli procedure over a 7-year period. One hundred and seventeen were assessed with the help of a questionnaire and, of these, 55 patients attended for clinical evaluation. The mean follow-up was 4 (1–8) years. There were 72 patients with dynamic scapholunate instability and 45 patients with static instability. The average age was 38 years. There were 50 males and 67 females. A total of 77 (62%) patients had no to mild pain with a mean visual analogue score of 3.67 ( SD = 2.5 ) . The loss in the arc of flexion–extension was due to a reduced range of flexion (mean loss 31%), while 80% of extension was maintained, compared with the contralateral side. The grip strength on the operated side was reduced by 20% of the non-operated side. There was no statistically significant difference ( P > 0.05 ) in the range of movement or the grip strength between the static and dynamic group and patients with or without legal claims. Ninety (79%) patients were satisfied with the result of the surgery (good to excellent) and 88% of the patients felt that they would have the same surgery again. We feel that these results compare favourably with the early results published from this unit and recommend this procedure for dynamic and static scapholunate instability.