Diagnostic accuracy of standard practice wrist MRI for scapholunate ligament injuries: a retrospective arthroscopic correlation study

Introduction The scapholunate ligament is the most injured intercarpal ligament. Untreated tears can lead to carpal instability and subsequent radiocarpal and midcarpal osteoarthritis. While wrist arthroscopy remains the gold standard, the diagnostic performance of standard practice preoperative MRI in clinical practice warrants further investigation. Methods We retrospectively analysed patients who underwent preoperative wrist MRI followed by wrist arthroscopy between 2013 and 2021. MRI findings regarding scapholunate ligament integrity were compared with arthroscopic findings serving as reference standard. Sensitivity and specificity were calculated for detection of any scapholunate ligament lesion (partial or complete tear). Results A total of 889 patients were included. Complete paired data were available for 864 patients with a mean age of 42.4 ± 15.4 years (range 10–83 years). 51.3% were male. MRI classified the ligament as intact in 83.9%, partially ruptured in 9.1%, and completely ruptured in 6.9%. Arthroscopy identified intact ligaments in 78.2%, partial tears in 12.9%, and complete tears in 8.9%. In this cohort, MRI demonstrated high specificity (91.1%, 95% CI 89.0–93.3) but limited sensitivity (42.0%, 95% CI 35.0–49.1) for scapholunate ligament lesions. Conclusion In standard clinical practice, preoperative wrist MRI shows high specificity but insufficient sensitivity for detecting scapholunate ligament injuries. In this cohort, MRI detected intact ligaments reliably, but a relevant proportion of partial and complete tears remained unrecognized.