5/10/2013 Disclosures Tenodesis Screw Fixation of Tendon Graft for Scapholunate Dissociation: � None Biomechanical Analysis of a New Surgical Technique Jun Y. Matsui, M.D. Safa Herfat, Ph.D. Lisa Lattanza, M.D. UCSF Orthopaedic Surgery Inman Abbott Conference May 10, 2013 Outline Introduction - Scapholunate Anatomy Introduction � Osseous Methods � Ligamentous Results – Preliminary � Volar Discussion � Dorsal Short, JHS 2009 Mitsuyasu, JHS 2004 Elsaidi, CORR 2004 Viegas, JHS 1999 1
5/10/2013 Introduction – Scapholunate Dissociation Complete SL dissociation � Primary repair � Capsulodesis � RASL � Ligament reconstruction � Intercarpal fusions SLAC (salvage) Meade at al. J Hand Surg 1990 Pollock et al, J Hand Surg 2010 Modified Brunelli Our technique: the beginning � Goals � Withstands stress over time � Stronger fixation � Reduce technical challenge of the scaphoid tunnel � All-dorsal approach � Tenodesis screws 2
5/10/2013 New Technique New Technique 3mm tenodesis screws Materials testing machine Finger flexors (8) raises and lowers to achieve Methods connected to materials full grip and extension testing machine � 6 paired cadaver specimen � Free of pre-existing wrist injury � SL diastasis and DISI: SLIL, DRC, DIC � Modified Brunelli or new technique � Repetitive grip loaded in jig with 100N load � Fatigue tested � Interval measurements scapholunate gap and angle Meade at al. J Hand Surg 1990 Pollock et al, J Hand Surg 2010 Fingers attached to Wrist extensors (3) attached to 10lb weight Elsaidi, CORR 2004 Mitsuyasu, J Hand Surg 2004 2.5lb weight Short, J Hand Surg 2009 3
5/10/2013 Cycles 0 100 200 1000 Modified Brunelli Preliminary Results � 2 pairs � Modified Brunelli � Evidence of dynamic gap at 100 Gap: 1.64 Gap: 3.35 Gap: 4.05 Gap: 3.92 Angle: 49 Angle: 48 Angle: 56 Angle: 55 cycles 0 200 5000 � Static gap at 200 cycles New Technique � New technique � No evidence of gap or DISI at 5000 cycles Gap: 1.87 Gap: 2.03 Gap: 1.91 Angle: 53 Angle: 52 Angle: 53 Discussion � New technique: � SLIL and DIC � Fixation � Eliminates tunnel � Auto or allograft options � Leaves unsolved � DRC – did not want to cross the wrist � Volar ligaments � Effect of healing, scarring Modified Brunelli New Technique 4
5/10/2013 Conclusions Future Studies: Clinical � When there are >5 proposed � Long term follow up procedures for the same problem, � Pain there is no right answer… yet � Arthritis � Grip strength � This new technique potentially reduces � Wrist range of motion surgical morbidity, restores dorsal anatomy � Scapholunate gap, angle which is the most important, and allows for tendon-bone healing � Prospective randomized clinical trial � Biomechanical studies should be followed by clinical studies References THANK YOU! Bleuler P et al. Dynamic repair of scapholunate dissociation with dorsal extensor carpi radialis longus tenodesis. J hand Surg 2008; 33A: 281- � 284. � Dr. Lisa Lattanza Boileau P et al. Arthroscopic treatment of isolated Type II SLAP lesions: biceps tenodesis as an alternative reinsertion. Am J Sports Med 2009; � 37 (5): 929-936. Brunelli GA, Brunelli GR. A new technique to correct carpal instability with scaphoid rotary subluxation: A preliminary report. J Hand Surg [Am] � 1995; 20:S82-S85. � Safa Herfat, Ph. D. Chabas JF et al. Results of the Modified Brunelli Tenodesis for Treatment of Scapholunate Instability: A Retrospective Study of 19 Patients. J � Hand Surg 2008: 33A: 1469-1477. Golish SR et al. Interference screw versus suture anchor fixation for subpectoral tenodesis of the proximal biceps tendon: a cadaveric study. � Arthroscopy 2008; 24(10): 1103-1108. Heinzelmann AD et al. A combined technique for distal biceps repair using a soft tissue button and biotenodesis intererence screw. Am J Sports � Med 2009; 37: 989. � Erik McDonald, B.S. Howlett JPC et al. Distal tunnel placement improves scaphoid flexion with the Brunelli tenodesis procedure for scapholunate dissociation. J Hand � Surg 2008; 33A: 1756-1764. Kuo CE and Wolfe SW. Scapholunate Instability: Current concepts in diagnosis and management. J Hand Surg 2008; 33A: 998-1013. � � Jenni Buckley, Ph.D. Kusma et al. Tenodesis of the long head of the biceps brachii: Cyclic testing of five methods of fixation in a porcine model. J shoulder Elbow � Surg 2008; 17: 967-973. Lee SK et al. Fixation of tendon grafts for collateral ligament reconstructions: A cadaveric biomechanical study. J Hand Surg 2005; 30A: 1051- � 1055. Links AC et al. Scapholunate Interosseous Ligament Reconstruction: results with a Modified Brunelli Technique versus Four-Bone Weave. J � Hand Surg 2008; 33A:850-856. Marcuzzi A et al. Ligamentous reconstruction of scaphlunate dislocation through a double dorsal and palmar approach. J Hand Surg 2006; 31B � (4): 445 – 449. Mazocca AD et al. Biomechanical evaluation of 4 techniques for distal biceps brachii tendon repair. Am J Sports Med 2006; 35 (2): 252 – 258. � Millet PJ et al. Interference screw vs. suture anchor fixation for open subpectoral biceps tenodesis: Does it matter? BMC Musculoskel Disord � 2008; 9:121. Ozalay M et al. Mechanical Strength of Four Different Biceps Tenodesis Techniques. Arthroscopy 2005; 21(8): 992-998. 5
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