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Interdisciplinary consensus statements on imaging of scapholunate joint instability

Tobias Dietrich, Andoni Paul Toms, Luis Cerezal, Patrick Omoumi, Robert Downey Boutin, Jan Fritz, Rainer Schmitt, Maryam Shahabpour, Fabio Becce, Anne Cotten, Alain Blum, Marco Zanetti, Eva Llopis, Maciej Bień, Radhesh Krishna Lalam, P Diana Afonso, Vasco V Mascarenhas, Reto Sutter, James Teh, Grzegorz Pracoń, Milko C De Jonge, Jean-Luc Drapé, Marc Mespreuve, Alberto Bazzocchi, Guillaume Bierry, Danoob Dalili, Marc Garcia-Elias, Andrea Atzei, Gregory Ian Bain, Christophe L Mathoulin, Francisco Del Piñal, Luc Van Overstraeten, Robert M Szabo, Emmanuel J Camus, Riccardo Luchetti, Adrian Julian Chojnowski, Jörg G Grünert, Piotr Czarnecki, Fernando Corella, Ladislav Nagy, Michiro Yamamoto, Igor O Golubev, Jörg Van Schoonhoven, Florian Goehtz, Maciej Klich & Iwona Sudoł-Szopińska

abstract

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.
   
citation Dietrich T, Toms A P, Cerezal L, Omoumi P, Boutin R D, Fritz J, Schmitt R, Shahabpour M, Becce F, Cotten A, Blum A, Zanetti M, Llopis E, Bień M, Lalam R K, Afonso P D, Mascarenhas V V, Sutter R, Teh J, Pracoń G, De Jonge M C, Drapé J L, Mespreuve M, Bazzocchi A, Bierry G, Dalili D, Garcia-Elias M, Atzei A, Bain G I, Mathoulin C L, Del Piñal F, Van Overstraeten L, Szabo R M, Camus E J, Luchetti R, Chojnowski A J, Grünert J G, Czarnecki P, Corella F, Nagy L, Yamamoto M, Golubev I O, Van Schoonhoven J, Goehtz F, Klich M, Sudoł-Szopińska I. Interdisciplinary consensus statements on imaging of scapholunate joint instability. Eur Radiol 2021; 31:9446-9458.
   
type journal paper/review (English)
date of publishing 08-06-2021
journal title Eur Radiol (31/12)
ISSN electronic 1432-1084
pages 9446-9458
PubMed 34100996
DOI 10.1007/s00330-021-08073-8