Imaging assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears: what is the best option for quantitative assessment?

Objective: To compare four different methods for the quantitative assessment of dorsal scaphoid displacement in patients with scapholunate ligament tears.

Methods: A total of 160 consecutive patients who underwent CT arthrography to evaluate a suspected scapholunate ligament tear were prospectively included in this study approved by the local ethics committee. MR images were available for 65 of these patients. Two readers independently evaluated the dorsal scaphoid displacement on conventional radiographs with the dorsal tangential line (DTL) method, the posterior radioscaphoid angle (PRSA) on both CT and MR, and the radioscaphoid congruency ratio on MR. These measurements were compared in groups of patients with and without scapholunate ligament tears.

Results: The measurement interobserver agreement was considered excellent for the DTL and the PRSA on CT (ICC = 0.93 and 0.88, respectively), good for the PRSA (ICC = 0.65) on MR, and moderate for the RSCR (ICC = 0.49). There was a significant increase in the values of DTL and PRSA on CT between patients with normal and ruptured SLIL (p < 0.0001). The same tendency was seen on MR-based methods, but these differences were only significant for one reader. The only method that allowed the differentiation between patients with normal and partially ruptured SLIL was the PRSA on CT. PRSA on CT yielded the best diagnostic performance for SLIL rupture (a sensitivity and a specificity of 70-82% and 70-72%).

Conclusion: DTL on standard radiographs and the PRSA on CT are the most consistent imaging indicators of SDD with an excellent interobserver reproducibility.

Key Points: • Dorsal scaphoid displacement is an important prognostic factor in patients with scapholunate instability. • Quantitative assessment of dorsal scaphoid displacement can be performed on conventional radiographs and CT with an excellent reproducibility. • The posterior radioscaphoid angle on CT yielded the best diagnostic performance for the identification of scapholunate ligament tears and the only method allowing differentiation between patients with normal and partially torn ligaments.