Full Length Article The management of chronic non-arthritic scapholunate dissociation: a systematic review Zafar Naqui 1 , Wee Sim Khor 1 , Anuj Mishra 2 , Vivien Lees 2 and Lindsay Muir 1 Abstract A systematic review was conducted to identify the best management for chronic scapholunate dissociation. EMBASE, MEDLINE, and CENTRAL were searched from 1965–2016. A narrative synthesis was performed. One thousand, one hundred and ninety-one citations were identified, of which 17 had final analysis. In all inter- ventions, the pain score at 2 years reduced from 6.0 to 2.8 with similar effect from capsulodesis and tenodesis techniques. Overall there was an 18% loss of flexion arc. Radial to ulnar arc improved in capsulodesis (þ19%; n ¼ 45) and worsened in tenodesis (6%; n ¼ 45). Grip strength was better in capsulodesis (þ31%; n ¼ 64 versus þ 11%; n ¼ 56). There was insufficient evidence to link radiological outcome with clinical outcome. Rates of complications (20%) and CRPS (3.8%) were high, with implications for patient consent. Due to het- erogeneity in data collection, the lack of comparative studies and short-term follow-up, no conclusion regard- ing the superiority of a single technique was possible. Longer term comparative studies are required, as are natural history studies. A minimum data set has been advised. Level of evidence: II Keywords Scapholunate ligament, scapholunate dissociation, systematic review Date received: 3rd January 2017; revised: 6th September 2017; accepted: 12th September 2017 Introduction There is no consensus on the optimal management of chronic scapholunate ligament (SLIL) injuries (Bloom et al., 2003; Zarkadas et al., 2004). Left untreated, it has been understood that scapholunate dissoci- ation will lead stepwise to progressive arthritis within the wrist (Watson et al., 1997). Numerous different techniques have been advocated for the treatment of non-arthritic chronic scapholunate instability (Table 1). We believe this is the first systematic review to address the manage- ment of this condition. Methods Studies of all languages were identified by searching EMBASE, MEDLINE and CENTRAL (Online Appendix 1). The study followed PRISMA-P guidelines (Online Appendix 2) and was registered on PROSPERO. The primary outcome that was considered most important was pain. The key secondary outcomes were range of wrist motion, grip strength, return to pre-injury function, scapholunate angle, scapholu- nate gap, complications, and patient-reported out- come measures. Two reviewers (ZN and AM) independently screened all the titles and abstracts using criteria stated in Online Supplementary Table 1. Full text art- icles were screened by two independent reviewers (ZN and LM) following the PICO model (Online 1 Manchester Hand Centre, Salford Royal NHS Foundation Trust, Salford, UK 2 Manchester Hand Centre, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK Corresponding Author: Zafar Naqui, Manchester Hand Centre, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK. Email: zafnaqui@gmail.com Journal of Hand Surgery (European Volume) 0(0) 1–8 ! The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1753193417734990 journals.sagepub.com/home/jhs