[Wrist_02] Scapholunate ligament tear and Dorsal capsulo-scapholunate septum tear

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The scapholunate ligament (SLL) is a C-shaped structure, and has 3 histologically and functionally distinct components, dorsal, volar and proximal (interosseous) components.

 

The dorsal part of the scapholunate ligament (SLL) is the strongest and most important component of the SLI ligament.

The dorsal segment is a true histologic articular ligament, with normally taut transversely oriented collagen fascicles.

The normal dorsal component appears consistently thicker, band-like and lower in signal intensity compared to the volar component

 

The volar segment of the SLL is a much thinner ligament (no more than 1 mm thick), with slightly obliquely oriented collagen fibers from proximal-ulnar to distalradial.

The volar component often shows striated heterogenous increased signal intensity, particularly on GRE sequences, probably related to associated loose vascular connective tissue.

 

We sometimes mistake the long radiolunate ligament for the volar scapholunate ligament. A long radiolunate ligament is shown connected from the radius to the lunate.

 

The proximal or membranous segment is grossly anisotropic fibrocartilage rather than a true ligament without oriented collagen or neurovascular investment.

Most of the fibrocartilaginous proximal SLL is the weakest part of the SLL, prone to degenerative perforations, and does not contribute to stabilization. Usually, there is a meniscus-like extension that protrudes into the scapholunate joint space, with wedge-shaped or triangular 

 

Secondary scapholunate stabilization is a complicated and debated subject, with contributions from muscles and tendons, volar and dorsal intrinsic and extrinsic ligaments, and a structure that has recently received a great deal of attention, the dorsal capsulo-scapholunate septum (DCSS).

 

The dorsal capsulo-scapholunate septum (DCSS) is best imaged in the sagittal plane and can be seen coursing distally and dorsally from the scapholunate ligament (SLL) and dorsal intercarpal ligament (DIC) to attach to the radiocarpal capsule.

 

Degree of SL instability (Geissler Grade 2) in individuals with an arthroscopically diagnosed DCSS detachment from the scapholunate ligament (SLL).

Subsequent arthroscopic repair of the DCSS to the dorsal SLL appeared to be a successful treatment option with excellent postoperative results

 

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