Arthroscopy for Persistent Pain after Scapholunate Internal Brace Reconstruction: A Case Report

Abstract Scapholunate (SL) ligament injuries remain challenging to diagnose and treat. Internal brace ligament augmentation has provided an additional mechanism to improve initial stability of the construct and allow for earlier rehabilitation. Despite promising early outcomes, the durability of these constructs and their long-term outcomes remain incompletely understood. The following case report details a young, high-demand athlete with persistent wrist pain following a dorsal SL reconstruction with internal brace ligament augmentation. Postoperative radiographs and MRI demonstrated restored and maintained carpal alignment without evidence of recurrent SL dissociation. Due to persistent symptoms, diagnostic wrist arthroscopy was performed, revealing rupture of the dorsal SL reconstruction and internal brace construct with full-thickness cartilage loss on the distal radius articular surfaces. This case demonstrates that SL reconstructions with internal brace augmentation may fail despite normal radiographic and MRI findings, and that postoperative imaging may not always accurately reflect the mechanical integrity of a reconstruction. Although internal brace constructs function to provide mechanical reinforcement and allow for earlier rehabilitation postoperatively, they do not eliminate the risk of delayed, construct-dependent failure. Persistent postoperative wrist pain despite normal imaging parameters warrants careful clinical evaluation, and arthroscopy remains the gold standard for diagnosing occult instability and construct failure, especially when symptoms are disproportionate to imaging findings. : Level IV, case report.