Publikation
Interdisciplinary consensus statements on imaging of scapholunate joint instability
Wissenschaftlicher Artikel/Review - 08.06.2021
Sudoł-Szopińska Iwona, Szabo Robert M, Van Overstraeten Luc, Del Piñal Francisco, Mathoulin Christophe L, Bain Gregory Ian, Atzei Andrea, Garcia-Elias Marc, Dalili Danoob, Bierry Guillaume, Camus Emmanuel J, Luchetti Riccardo, Chojnowski Adrian Julian, Klich Maciej, Goehtz Florian, van Schoonhoven Jörg, Golubev Igor O, Yamamoto Michiro, Nagy Ladislav, Corella Fernando, Czarnecki Piotr, Grünert Jörg G, Bazzocchi Alberto, Mespreuve Marc, Cotten Anne, Becce Fabio, Shahabpour Maryam, Schmitt Rainer, Fritz Jan, Boutin Robert Downey, Omoumi Patrick, Cerezal Luis, Toms Andoni Paul, Blum Alain, Zanetti Marco, Llopis Eva, Drapé Jean-Luc, de Jonge Milko C, Pracoń Grzegorz, Teh James, Sutter Reto, Mascarenhas Vasco V, Afonso P Diana, Lalam Radhesh Krishna, Bień Maciej, Dietrich Tobias
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OBJECTIVES
The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.
METHODS
Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors' clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of '0', '5' and '10' reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of '8' or higher for 80% or more of the panellists.
RESULTS
Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.
CONCLUSIONS
Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.
KEY POINTS
• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability. • Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability. • Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.