Interdisciplinary consensus statements on imaging of scapholunate joint instability
Authors: Dietrich Tobias Johannes , Toms Andoni Paul , Cerezal Luis , Omoumi Patrick , Boutin Robert Downey , Fritz Jan , Schmitt Rainer , Shahabpour Maryam , Becce Fabio , Cotten Anne , Blum Alain , Zanetti Marco , Llopis Eva , Bień Maciej , Lalam Radhesh Krishna , Afonso P. Diana , Mascarenhas Vasco V. , Sutter Reto , Teh James , Pracoń Grzegorz , de Jonge Milko C. , Drapé Jean-Luc , Mespreuve Marc , Bazzocchi Alberto , Bierry Guillaume , Dalili Danoob , Garcia-Elias Marc , Atzei Andrea , Bain Gregory Ian , Mathoulin Christophe L. , del Piñal Francisco , Van Overstraeten Luc , Szabo Robert M. , Camus Emmanuel J. , Luchetti Riccardo , Chojnowski Adrian Julian , Grünert Jörg G. , Czarnecki Piotr , Corella Fernando , Nagy Ladislav , Yamamoto Michiro , Golubev Igor O. , van Schoonhoven Jörg , Goehtz Florian , Klich Maciej , Sudoł-Szopińska Iwona 
Published: June 2021

Abstract
Objectives
The purpose of this agreement was to establish evidence-based consensus statements on imaging of scapholunate joint (SLJ) instability by an expert group using the Delphi technique.

Methods
Nineteen hand surgeons developed a preliminary list of questions on SLJ instability. Radiologists created statements based on the literature and the authors’ clinical experience. Questions and statements were revised during three iterative Delphi rounds. Delphi panellists consisted of twenty-seven musculoskeletal radiologists. The panellists scored their degree of agreement to each statement on an eleven-item numeric scale. Scores of ‘0’, ‘5’ and ‘10’ reflected complete disagreement, indeterminate agreement and complete agreement, respectively. Group consensus was defined as a score of ‘8’ or higher for 80% or more of the panellists.

Results
Ten of fifteen statements achieved group consensus in the second Delphi round. The remaining five statements achieved group consensus in the third Delphi round. It was agreed that dorsopalmar and lateral radiographs should be acquired as routine imaging work-up in patients with suspected SLJ instability. Radiographic stress views and dynamic fluoroscopy allow accurate diagnosis of dynamic SLJ instability. MR arthrography and CT arthrography are accurate for detecting scapholunate interosseous ligament tears and articular cartilage defects. Ultrasonography and MRI can delineate most extrinsic carpal ligaments, although validated scientific evidence on accurate differentiation between partially or completely torn or incompetent ligaments is not available.

Conclusions
Delphi-based agreements suggest that standardized radiographs, radiographic stress views, dynamic fluoroscopy, MR arthrography and CT arthrography are the most useful and accurate imaging techniques for the work-up of SLJ instability.

Key Points
• Dorsopalmar and lateral wrist radiographs remain the basic imaging modality for routine imaging work-up in patients with suspected scapholunate joint instability.
• Radiographic stress views and dynamic fluoroscopy of the wrist allow accurate diagnosis of dynamic scapholunate joint instability.
• Wrist MR arthrography and CT arthrography are accurate for determination of scapholunate interosseous ligament tears and cartilage defects.