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Scapholunate injuries: challenging existing dogmas in anatomy and surgical techniques

The management of scapholunate injuries and dissociation remains debatable. Traditional methods of fixation had centred around open procedures, but advances in wrist arthroscopic techniques has redefined both major anatomical findings and operative approaches. This article challenges two main existing dogmas: first, the anatomy of the scapholunate ligament and second, the management of these injuries. For the first, we propose that scapholunate stability is in fact maintained by a whole anatomic complex, consisting of well-defined capsuloligamentous structures and extrinsic ligaments, and that the scapholunate ligament itself probably has a limited role. For the second, we challenge the notion that scapholunate injuries often require open procedures and propose that mini-invasive arthroscopic dorsal repair of the scapholunate complex is an efficient technique and sufficient for achieving long-term stability.