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.