Carpal ligamentous injury in children and adolescents: a systematic review

Carpal ligamentous injuries in children and adolescents are uncommon yet often underappreciated. This systematic review aims to consolidate existing evidence regarding scapholunate (SL), lunotriquetral (LT), and perilunate injuries in patients aged 16 years and younger while exploring potential management strategies. We conducted a PRISMA-compliant systematic review, sourcing data from PubMed/MEDLINE, Embase, Scopus, and Web of Science from inception to October 2025. Studies focusing on SL, LT, or perilunate injuries in pediatric patients that documented treatment and included at least three months of follow-up were selected. Two reviewers independently screened the studies. Due to diversity in the data, results were synthesized narratively. A good clinical outcome was defined as minimal pain (VAS < 2), flexion-extension ≥ 50 °, and grip strength > 80% of the contralateral side. Twenty-two studies were identified, detailing 62 SL injuries, 13 perilunate injuries, and 2 isolated LT injuries. The majority were case reports, with only two retrospective cohort studies on SL injuries. SL injuries often co-occurred with distal radius fractures and usually necessitated arthroscopy for accurate diagnosis. While case reports indicated favorable outcomes, cohort studies exhibited greater variability in recovery, particularly with delayed interventions. For unstable SL lesions, arthroscopic debridement combined with scapholunate pinning showed promising functional outcomes. Concerning perilunate injuries, both surgical and non-surgical treatments were documented, with closed reduction and subsequent immobilization yielding satisfactory results in approximately 87.5% of cases. Notably, only one instance of long-term growth disturbance was reported. Isolated LT injuries were managed with arthroscopic debridement and pinning, allowing athletes to safely return to sports. Current evidence regarding carpal ligamentous injuries in the pediatric population is limited and primarily derived from small, heterogeneous case series. Early intervention appears to correlate with improved functional outcomes in SL injuries, with arthroscopy being crucial for accurate diagnosis. In select cases of perilunate injury, closed reduction followed by immobilization may offer satisfactory results. Given the limitations, these findings warrant cautious interpretation, emphasizing the need for higher-quality prospective studies in this area. Systematic Review, Level IV.