Article

Intercarpal instability is often secondary to a scapholunate interosseous (SLIO)
ligament lesion. Its reconstruction is thus essential. Classical capsulodesis
techniques fix the scaphoid in extension and do not reproduce the physiologic
ligamentous isometry of the wrist. The authors use the technique of Viegas, which
seems to respect this isometry : the dorsal intercarpal ligament is re-inserted
dorsally to reattach the capsule on the dorsal SLIO and to reinforce it. Between
2006 and 2010, 25 wrists were operated on in 12 men and 12 women of mean age 38
years. All patients presented with pain often associated with loss of power,
decreased mobility or a debilitating click. The mean follow-up was 26 months.
Postoperative and preoperative data were compared. Flexion/extension range
increased by 2.6 degrees , radioulnar deviation increased by 21.1 degrees . Grip
strength increased by 8.7 kgf. Pain decreased by 3 points on the VAS and the PRWE
improved by 59 points.
We observed four CRPS, one EPL lesion and one case of
superficial track pin infection. We got eleven excellent results, nine good, two
moderate and three bad, two of which were re-operated. Viegas' capsulodesis does
not present major technical difficulty. The results show no stiffness in
flexion/extension. There was evident improvement in radioulnar deviation, grip
strength, pain and PRWE scores. This technique provides effective treatment for a
difficult or irreparable lesion of the SLIO ligament, without fixed carpal
instability corresponding to Geissler arthroscopic stages 2
to 4 and Garcia-Elias
stages 3 and 4. The capsulodesis produces an effective stabilization without
stiffness. Precautions should be undertaken to avoid CRPS and pin complications.
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Langue : ANGLAIS