Disclosures Tenodesis Screw Fixation of Tendon Graft for - - PowerPoint PPT Presentation

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Tenodesis Screw Fixation of Tendon Graft for Scapholunate Dissociation: 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

Disclosures

None

Introduction Methods Results – Preliminary Discussion

Outline Introduction - Scapholunate Anatomy

Osseous Ligamentous Volar Dorsal

Short, JHS 2009 Mitsuyasu, JHS 2004 Elsaidi, CORR 2004 Viegas, JHS 1999

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Introduction – Scapholunate Dissociation

Meade at al. J Hand Surg 1990 Pollock et al, J Hand Surg 2010

SLAC

Complete SL dissociation

Primary repair Capsulodesis RASL Ligament reconstruction Intercarpal fusions

(salvage)

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

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3mm tenodesis screws

New Technique

New Technique Methods

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 Elsaidi, CORR 2004 Mitsuyasu, J Hand Surg 2004 Short, J Hand Surg 2009

Fingers attached to 2.5lb weight Wrist extensors (3) attached to 10lb weight Materials testing machine raises and lowers to achieve full grip and extension Finger flexors (8) connected to materials testing machine

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Preliminary Results

2 pairs Modified Brunelli

Evidence of dynamic gap at 100

cycles

Static gap at 200 cycles

New technique

No evidence of gap or DISI at 5000

cycles

Cycles

Modified Brunelli New Technique 100 200 1000 200 5000

Gap: 1.64 Angle: 49 Gap: 3.92 Angle: 55 Gap: 2.03 Angle: 52 Gap: 4.05 Angle: 56 Gap: 1.91 Angle: 53 Gap: 1.87 Angle: 53 Gap: 3.35 Angle: 48

Modified Brunelli New Technique

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

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Future Studies: Clinical

Long term follow up

Pain Arthritis Grip strength Wrist range of motion Scapholunate gap, angle

Prospective randomized clinical trial

Conclusions

When there are >5 proposed

procedures for the same problem, there is no right answer… yet

This new technique potentially reduces

surgical morbidity, restores dorsal anatomy which is the most important, and allows for tendon-bone healing

Biomechanical studies should be followed by

clinical studies

References

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• Brunelli GA, Brunelli GR. A new technique to correct carpal instability with scaphoid rotary subluxation: A preliminary report. J Hand Surg [Am]

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• Chabas JF et al. Results of the Modified Brunelli Tenodesis for Treatment of Scapholunate Instability: A Retrospective Study of 19 Patients. J

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• Dr. Lisa Lattanza

Safa Herfat, Ph. D. Erik McDonald, B.S. Jenni Buckley, Ph.D.

THANK YOU!