Arthroscopic Dorsal Scaphotriquetral Ligamentoplasty for Dynamic Scapholunate Instability

Dynamic scapholunate (SL) and lunotriquetral (LT) instabilities represent challenging clinical problems that may lead to progressive carpal collapse and degenerative arthritis if left untreated. 1)While various treatment methods have been introduced, achieving durable carpal stability while preserving wrist motion remains a significant clinical challenge.The stability of the proximal carpal row (PCR) depends on the integrity of the intrinsic interosseous ligaments, which act as primary stabilizers, and the extrinsic ligaments, which serve as secondary stabilizers.Several anatomical and biomechanical studies reported that the dorsal intercarpal ligament (DIC) and the dorsal radiocarpal ligament (DRC) play a more critical role in stabilizing the SL joint than previously believed. 2,3)The integrity of the DIC is crucial for maintaining carpal stability, alignment, and normal carpal kinematics.Berger 4) suggested that the dorsal scaphotriquetral ligament (DST), comprising proximal DIC fibers, plays an important role in transverse stabilization of the PCR.The DRC, DIC, and DST are vital for reinforcing the scapholunate intercarpal ligament (SLIL) and lunotriquetral intercarpal ligament (LTIL), thereby preventing dorsal instability of the midcarpal joint through stabilization of the capitate head.These ligaments also contribute to restricting dorsal lunate deformity throughout wrist motion.Based on this biomechanical rationale, several arthroscopic dorsal capsulodesis techniques have been developed to address dynamic carpal instability.Previous arthroscopic ligamentoplasty procedures, including DRC capsulodesis and dorsal capsuloligamentous complex capsulodesis techniques, have reported promising short-term outcomes.However, previous methods often require extensive dorsal capsular tissue manipulation, which results in limitations in range of motion. 5)Additionally, many existing techniques involve fixation of a suture anchor to the