chapter  15
8 Pages

Reduction and Association of the Scaphoid and Lunate (RASL) Reconstruction for Scapholunate Instability

The reduction and association of the scaphoid and lunate

(RASL) procedure can provide a predictable and satisfactory

means to treat irreparable, symptomatic scapholunate (SL)

ligament tears (1-3). SL ligament tears can occur as an isolated

injury due to a fall on the extended wrist involving axial load,

wrist extension, intercarpal supination, and ulnar deviation or

in conjunction with associated injuries such as distal radius

fractures, which may lead to a missed or delayed diagnosis (4).

Carpal ligament injuries represent a spectrum from isolated and

partial SL ligament tears involving only the thin central

membranous portion to perilunate or lunate dislocations with

involvement of both intrinsic and extrinsic carpal ligaments.

Ascertainment of the severity of injury can be difficult and a

“wrist sprain” may not recover with benign neglect. Fifty-five

percent of patients with chronic tears develop a predictable

pattern of arthritis, called scapholunate advanced collapse

(SLAC) (5). Thus, a timely diagnosis and effective treatment

are crucial for an optimal long-term outcome.