What is the ideal replacement for the scapholunate ligament in a chronic dissociation?
EJ Harvey, D Hanel An ideal replacement for the scapholunate ligament has not been found. The carpometacarpal bone-ligament-bone complex at the base of the third metacarpal can be used as a replacement for the scapholunate ligament. A cadaveric study of matched scapholunate ligament and third metacarpal-capitate was carried out. Data for stiffness and strength were obtained from fresh frozen specimens tested to failure with a hydraulic distractor. The third metacarpal-scaphoid ligament most closely approximated the stiffness and the strength of the scapholunate ligament. Operative replacement of the scapholunate ligament with the third metacarpal-scaphoid replacement was accomplished. Clinically, the performance of the operation is facile and, in the present study, was not associated with increased morbidity or duration of surgery compared with other options. This study indicates that the third carpometacarpal ligament approximates the mechanical properties of the scapholunate ligament
