Arthroscopic Vertical Dorsal Capsulodesis for Dynamic Scapholunate Instability: Midterm Clinical Outcomes of a Novel Technique

Scapholunate (SL) instability is the most common form of carpal instability and may progress to scapholunate advanced collapse (SLAC) wrist if untreated. Although various open surgical treatment options have been described, arthroscopic techniques offer minimally invasive stabilization with reduced morbidity. This study aimed to evaluate the clinical and functional outcomes of a novel arthroscopic procedure—vertical dorsal capsulodesis—for the management of dynamic SL instability up to Geissler/European Wrist Arthroscopy Society (EWAS) grade 3(c). We retrospectively reviewed 34 consecutive patients who underwent arthroscopic vertical dorsal capsulodesis between 2011 and 2023, with a minimum follow-up of 18 months. The technique involves placing a vertically oriented dorsal suture loop through the SL interval and capsule, reinforcing the dorsal SL complex without direct ligament repair. Feasibility is determined using a catch-test. Objective outcomes included wrist range of motion (ROM), grip strength, and key pinch strength compared with the contralateral side. Subjective outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH), the Patient-Rated Wrist and Hand Evaluation (PRWHE) questionnaires, and the Visual Analog Scale (VAS) for pain and satisfaction. Complications, salvage surgeries, and return-to-work rates were also recorded. At a mean follow-up of 70 months (range, 18–168), the operated wrist maintained 86% to 100% of contralateral ROM and 96% of grip strength. Mean DASH and PRWHE scores were 18.9 and 22.6, respectively, while mean VAS scores for pain and satisfaction were 1.9 and 1.6, respectively. All 31 patients eligible for return to work resumed their occupations postoperatively. Three patients (9%) underwent salvage surgery due to persistent pain or instability. Arthroscopic vertical dorsal capsulodesis offers reliable stabilization for dynamic SL instability while preserving wrist motion and strength. The technique is associated with high functional recovery, low complication incidence, and excellent patient satisfaction. Level IV, therapeutic case series.