Can Platelet-Rich Plasma (PRP) therapy help treat a scapholunate ligament tear?

PRP Therapy for Scapholunate Ligament Tears: Not Supported by Current Evidence

There is no evidence supporting the use of platelet-rich plasma (PRP) therapy for scapholunate ligament tears, and current guidelines do not recommend this treatment modality. The available evidence focuses exclusively on diagnostic imaging and surgical/conservative management strategies, with no mention of PRP or other biologic therapies for this injury.

Current Evidence-Based Treatment Approach

Initial Conservative Management for Partial Tears

• Gradual rehabilitation and progressive strengthening physical therapy is the recommended first-line treatment for partial scapholunate ligament tears 1
• Conservative treatment can achieve pain reduction and functional recovery in partial injuries, particularly in acute cases when secondary stabilizers remain intact 2
• Immobilization followed by structured rehabilitation shows better outcomes in acute injuries compared to chronic presentations 2

Surgical Intervention Indications

• Surgery is indicated for complete tears, reducible instability (Garcia-Elias stages 2-4), or failed conservative management 3
• Arthroscopic dorsal capsulo-ligamentous repair demonstrates significant improvements in pain (VAS reduction of 5.46 points), grip strength (93.4% of contralateral side), and function (DASH score improvement from 46 to 8.3) at mean 30-month follow-up 3
• One-stage surgical treatment of scapholunate instability combined with associated injuries (such as distal radius fractures) results in better subjective pain and functional outcomes compared to conservative management 4

Diagnostic Confirmation Required Before Treatment

Imaging Algorithm

• CT arthrography achieves nearly 100% sensitivity and specificity for detecting scapholunate ligament tears and is the gold standard diagnostic modality 5, 1, 6
• MRI at 3.0T shows sensitivities of 70-87% for scapholunate tears, which is adequate but inferior to CT arthrography 7
• MR arthrography provides superior accuracy compared to non-contrast MRI and identifies which specific ligament segments are torn—critical information for surgical planning 7, 5

Assessment of Injury Severity

• Conventional radiographs should be obtained first, looking for scapholunate diastasis >4mm and dorsal lunate tilt >10° indicating dorsal intercalated segmental instability 7, 5
• Evaluation must include assessment of extrinsic ligament integrity (dorsal intercarpal ligament, radiolunotriquetral ligament), as 44% of scapholunate injuries have concomitant extrinsic ligament damage 2
• Extrinsic ligament injury accompaniment correlates with higher baseline pain and disability scores 2

Critical Clinical Pitfalls

Avoid Relying on Standard MRI Alone

• Standard MRI has only moderate sensitivity (65-89%) and may miss the full extent of injury, particularly partial tears of biomechanically important dorsal fibers 6
• CT arthrography detects partial ligament tears more accurately than MR arthrography and has greater interobserver agreement 1

Treatment Timing Considerations

• Acute injuries (within 3 months) respond better to conservative treatment than chronic injuries 2
• Untreated scapholunate instability may progress to scapholunate advanced collapse (SLAC) wrist with degenerative arthritis, though the natural history remains controversial 8, 3
• There is no strong evidence (level 1 or 2) establishing whether early intervention prevents future arthritis 8

Why PRP Is Not Recommended

The complete absence of PRP in current guidelines and research literature for scapholunate ligament injuries reflects several factors:

• No published studies demonstrate efficacy of PRP for intrinsic wrist ligament healing
• The scapholunate ligament has poor intrinsic healing capacity due to limited vascularity, making biologic augmentation theoretically appealing but unproven
• Current treatment paradigms focus on mechanical stabilization (surgical repair/reconstruction) or conservative rehabilitation rather than biologic enhancement
• The American College of Radiology guidelines 7 and comprehensive reviews 9, 8 make no mention of PRP or other regenerative medicine approaches

The evidence-based approach remains conservative management for partial tears with intact secondary stabilizers, progressing to surgical repair or reconstruction for complete tears or failed conservative treatment.