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Incidence and Pattern of Degeneration in the Scapholunate Interosseous Ligament: A Cadaveric Study
ABSTRACT
Instability of the scapholunate articulation from traumatic tears or degenerative attenuation of the interosseous ligament is associated with progressive collapse and degeneration of the wrist. Degenerative arthritis in such cases follows a consistent radiographic pattern that begins at the radioscaphoid articulation. The incidence of degenerative tears in the scapholunate interosseous ligament is unknown as radiographic changes appear late in the process.
The prevalence of age-related structural changes in the scapholunate interosseous ligament was documented and a wear pattern was established. The correlation, if any, between occupation and degenerative changes also was studied. To our knowledge, changes in the scapholunate ligament with age have not been previously studied.
Twenty paired specimens were harvested for study from embalmed cadavers with an average age of 71.2 years. The specimens were examined by visual observation under magnification and findings were recorded with digital photographs. The three parts of the ligament as described by Berger et al were studied individually. The gross pathological changes were graded as perforation, attenuation, or rupture to indicate increasing degree of ligament wear severity. The data obtained were correlated with sex, age, and occupation of the donors.
Our results indicated approximately 50% of wrists in the elderly demonstrate degenerative changes in the scapholunate interosseous ligament. The incidence increases with age, rising to 80% after age 70 years. Articular surface wear is almost always associated with ligament degeneration. The type of occupation, manual or sedentary, does not appear to have an affect on the prevalence of degeneration in the ligament. Degenerative changes tend to start at the palmar portion of the scapholunate interosseous ligament and affect the dorsal part of the ligament least, correlating with previous biomechanical studies that suggest the dorsal limb of the ligament is the strongest.