Treatment of static scapholunate instability with modified Brunelli tenodesis: results over 10 years.

PURPOSE: To examine the long-term results of the modified Brunelli tenodesis using a strip of the flexor carpi radialis tendon as a ligament substitute to maintain reduced rotatory subluxation of the scaphoid for scapholunate instability.
METHODS: Between 1995 and 1998, 10 patients with scapholunate instability underwent the modified Brunelli procedure. We reviewed 8 patients with static instability with a mean follow-up of 13.8 years (range, 12-15 y). The mean age of patients was 40 years at the time of surgery. The mean period from the injury to surgical treatment was 4 months.
RESULTS: The functional outcome according to Green and O'Brien was excellent or good in 7 of 8 patients. Postoperative Disabilities of the Arm, Shoulder, and Hand and modified Mayo scores averaged 9 and 83, respectively. At final follow-up, average total wrist motion and grip strength were 85% of the opposite normal side. Of the 8 patients, 6 were pain free; 1 patient had slight and occasional pain, and another had chronic pain. On radiographs, the average preoperative scapholunate gap was 5.1 mm. It was corrected to 2.4 mm at surgery and was 2.8 mm at final follow-up. The average scapholunate angle was 72° preoperatively, 46° postoperatively, and 63° at final follow-up. We observed degenerative osteoarthritis in 1 case.
CONCLUSIONS: Because the number of cases is small, only a few conclusions can be made. At final follow-up there was a certain loss of scapholunate reduction. The fact that we observed arthritic changes in only 1 of 8 cases suggests that carpal stability obtained by this procedure is probably sufficient to obtain good functional long-term results. Long-term studies with more cases are required to evaluate this method, which has shown encouraging results in the present study. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.