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L’intérêt de l’imagerie dynamique 4-Dimensions dans la prise en charge chirurgicale des instabilités scapho-lunaires

Abstract : Scapholunate instability is challenging to diagnose and to treat. If left untreated, it contributes to the development of wrist osteoarthritis. In the static stage, diagnosis is obvious when a careful radiographic analysis is performed, but the choice of surgical treatment is not as straightforward. In the dynamic stage, diagnosis is harder to make solely based on static imaging methods (radiographs, CT or MR arthrogram), which means exploratory arthroscopy may be required prior to surgical treatment. Despite it is an invasive procedure, arthroscopy is considered by many surgical teams, as the gold standard to explore the scapholunate joint space. Dynamic imaging, such as the four-dimensional computed tomography (4DCT), can analyze changes in the carpal joint spaces during wrist movements. Given our prospective study’s findings, 4DCT appeared as a quantitative multiparametric and reproductible relevant tool for the diagnosis and prognosis of suspected scapholunate instability, including for patients with questionable radiography findings. Abnormal kinematic parameters values seem to be indicative of significant biomechanical changes in the dissociated wrists. Moreover, 4DCT analysis demonstrated correspondence with the arthroscopic dynamic analysis of the scapholunate joint space. Several ligamentoplasty techniques have been described to treat chronic reducible scapholunate instability without chondral lesions. Their common objective is to correct radiological anomalies in order to prevent risk of osteoarthritis. These procedures have served as the basis for several clinical studies and while all the latter share similar good clinical results, the radiographic aspect varies widely, with frequently the recurrence of radiological anomalies. Thus, we described the scapholunate intercarpal ligamentoplasty (SLIC) which uses a free Palmaris Longus graft to reconstruct the scapholunate complex. At short to mid-term follow-up, we report satisfactory clinical and radiological results, and no osteoarthritis wrist case. In a cadaver study, we reported the 4DCT evaluation of that ligamentoplasty and provided additional evidence of its effectiveness in reducing scapholunate instability and restoring scapholunate joint stability. Finally, we designed a device for guiding wrist movements in order to increase the reproducibility and homogeneity of the movement during dynamic imaging acquisition.
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Submitted on : Thursday, September 9, 2021 - 9:35:41 AM
Last modification on : Friday, September 10, 2021 - 10:34:16 AM

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  • HAL Id : tel-03338805, version 1

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Lionel Athlani. L’intérêt de l’imagerie dynamique 4-Dimensions dans la prise en charge chirurgicale des instabilités scapho-lunaires. Chirurgie. Université de Lorraine, 2021. Français. ⟨NNT : 2021LORR0059⟩. ⟨tel-03338805⟩

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