Contemporary research haven*t performed dynamic examination related to the long and short term. consequences of this techniques. A better understanding of the biomechanical function of the scapholunate ligament is necessary to facilitate decision…
ID
Source
Brief title
Condition
- Tendon, ligament and cartilage disorders
Synonym
Research involving
Sponsors and support
Intervention
Outcome measures
Primary outcome
The aim is to gain dynamic information (motion patterns) of the scaphoid
relative to the lunate. 3- Dimensional movement is divided in six parameters.
For comparison of the scaphoid relative to the lunate, twee mean parameters
(rotation and translation) have to be calculated. For these experiments the
apparent changes in position of the fragments with respect to each other are
displayed as a rotation
around a Helical Axis of Motion (HAM) and translations along the HAM. Our aim
is to determine a standard deviation of motion of the scaphoid and lunate using
a 95% confidence interval.
Secondary outcome
For analysis of the wrist joint, every motion (HAM), 3 translations parameters
and 3 rotation parameters of the carpal bones will be defined in relation to
radial positioning. Comparison of the operated and contralateral wrist of every
patient will be made. The expectation is that there is a significant change in
dynamic of the carpal during motion of the wrist after combined scapholunate
reconstruction. The hypothesis is that the volar reconstruction is not
physiological.
Background summary
Carpal stability is needed for a normal, painless function of the wrist joint
and subsequently of the hand. The scapholunate (SL) ligament has a crucial role
in this providing this stability. This ligament consists of a dorsal, proximal
and a palmar part. Literature tells us that the dorsal part anatomically is the
strongest and resistent part, and biomechanically the important part in
stabilisation. It facilitates rotation and keeps scaphoid en lunate together.
Recent 4D-CT studies support this theory by showing that the scapholunate
rotational axis runs through the dorsal proximal pole of the scaphoid.
Traumatic SL-ligament tears may lead to instability of the wrist. When left
untreated this may give pain and diminished grip strength in the short term and
degeneration of the wrist joint in the long term. When ligament repair is not
possible anymore, hand surgeons nowadays perform a ligament reconstruction,
using a tendon strip. Several techniques have been described, roughly
categorized in dorsal reconstructions and combined palmar/dorsal
reconstructions.
Study objective
Contemporary research haven*t performed dynamic examination related to the long
and short term. consequences of this techniques. A better understanding of the
biomechanical function of the scapholunate ligament is necessary to facilitate
decision making for choosing surgical reconstruction procedures and improving
consensus.
In this research we have chosen to evaluate biomechanics, with four-dimensional
computerized tomographic (4D-CT) in patients with restoration of the
scaphoid-lunate ligament with the combined dorsal and palmar technique. This
means that we compared range of motion in multiple axis (biomechanics) in the
scaphoid and the lunate carpal bones after this combined reconstruction. With
use of advanced 4D-CT it is capable to examine the wrist in motion.
Simultaneously abnormal motion can be compared with the contralateral wrist.
This way we hope to determine a standard deviation of motion between the
scaphoid and lunate and furthermore to specific improve innovation of operation
techniques. This study protocol is the first to obtain 4-dimensional and
quantitative data regarding the biomechanics of the wrist following combined
scaphoid-lunate ligament reconstruction, using in vivo motion analysis.
Objectives
1. Is the location of the scapholunate rotation axis altered after combined
palmar and dorsal scapholunate ligament reconstruction?
2. Is the range of motion of the wrist altered after combined palmar and dorsal
scapholunate ligament reconstruction?
Hypothesis: The volar (palmar) reconstruction is not physiological
Study design
This study is an observational pilot study.
Both wrists will be scanned and analyzed by our 4D-CT method during
flexion/extension and radioulnar deviation. A comparison is made in normal
kinematics between de wrists of individual patients, this to minimalize
anatomical variation. We will include participants from the Hand Clinic
Amsterdam and the Amsterdam University Medical Centre (AUMC) location Vumc.
Acquisition of the 4D data will be conducted at the Academic Medical Centre,
Amsterdam.
Participants are informed about the research trough an information brochure,
followed with a telephone conversation. After extensive information and written
informed consent, they participate in this study. No control group is needed
because of the information from the contralateral non-injured wrist of the
patient and data available from a former study group. All patients will undergo
a standard CT scan and the 4DCT protocol. No categorization will be performed.
Study burden and risks
The radiation exposure of 4D-CT scans in addition to conventional CT scanning
is estimated to be 0.4 mSv for the patients. We do not need a healthy control
group, since the contralateral wrist of the patient is routinely scanned as
clinical reference. The exposure is within the category IIa (0,1 - 1 mSv) of
the International Commission on Radiological Protection (ICRP), which qualifies
as: minor risk. Findings from 4D-CT scans will be used for a better decision
making for future patients with scapholunate ligament ruptures.
Meibergdreef 9
Amsterdam 1105 AZ
NL
Meibergdreef 9
Amsterdam 1105 AZ
NL
Listed location countries
Age
Inclusion criteria
Patients who underwent one-sided palmar and dorsal reconstruction of the SL
ligament after traumatic rupture with a maximum follow up of 5 years
Patients who are over the age of 16 years
Patients who are willing and able to give informed consent
Exclusion criteria
Surgical history of the carpus.
A history of trauma (treated with a cast or surgically) tot the contralateral
wrist
Not able to understand the written informed consent
Pregnancy
(Peri-)lunar dislocation
Pain, to the degree that the patient is not able or willing to move the hand
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| CCMO | NL75504.018.20 |