Scapholunate rupture - have repair surgery?

I'd welcome input on my torn/ruptured SLL in my right/dominate hand .  Ruptured two weeks ago (audible pop while bouldering), but was already sore (and probably strained) for some weeks.  X-rays and MRI confirmed rupture (scaphoid lunate gap is 5mm vs ~3mm in my left).

Doctor said at my age (50), there's not a clear best choice between "wait and see" vs. surgery (for a younger person, repair surgery is better, but I'm older and my pain level isn't that bad)..

I read through the older threads on similar injuries and am I'm leaning towards the repair surgery (drill scaphoid and lunate anchors and suture the ligament, pin/staple the bones together, and cast for 10 weeks), but would welcome other's thoughts as well as recommendations for hand surgeons in the Baltimore/DC area.

Fix it. 20 yrs later you will glad. The bones will slowly migrate (terry thomas sign) and OA set in. See a hand surgeon. I did the same in 1999 falling and dislocating 

I had a very similar injury with a fully ruptured scapholunate. Had surgery and have been climbing for the past two years harder than ever and pain free. Don't know any surgeons in the DC area, I'd just take the time to find a good one. My doc was much more encouraging of my prognosis after he had found a slightly different approach to the procedure that had been more broadly introduced in the last few years. 

Thanks to you both.  I did have the surgery (two out of ten weeks in the cast), and feel lucky it was acute so that a repair was still possible (I better understand now the difference between repair and reconstruction).  Any experience on what to expect for range of motion after rehab?

Glad the surgery went well and that it was just the repair. I had a pin in for about a month and was in a cast for about 8 weeks. After all my rehab, strength is fully returned, mobility is close. There is some tightness at the end of the range of my wrist extension, so I try to not to load it like that if possible (i.e. I generally do pushups on fists instead of my palms). Good luck with the rehab.

My mobility during PT exercises hugely benefitted from heat- so keep that wrist warm when you're doing your exercises once you're out of the cast!

Hey all glad to hear about your surgical success! and impressive recovery times

 I have this tear as of June 2025 - originally exam thought it was full rupture but the sucker is barely hanging on and no mechanical "clunking" in the wrist.  5 months of PT and cant do easy climbing/volume  without pain and repercussions the next day (soreness and less stability) 

 I got 2 opinions from surgeons,  one being a top sports hand orthopedic surgeon for Denver.  He said not to get the surgery -  it more often makes it worse and apologized for lack of repair options . Both Doctors agreed -its a tough surgery to perform and the recovery time post surgery is 6-8months to start "light use".  my questions are:

-did anyone else get this variety in opinions?

-who did you see? do you know the repair technique?  guess there are a bunch

Hey Stu-

I didn't get multiple opinions (probably should have), but dealt with a similar lack of progress just through PT. Based on my imaging, they thought it was a moderate tear, but during the surgery it became clear that it was nearly a full rupture. 

I saw Dr. Sameer Lodha at Panorama Ortho in Golden. He and his P.A. were both great. He brought up similar hesitation on the surgery, given that the success rate for it historically has not been very high. However, after speaking with him, he found another doc who worked with some pro baseball players in California and was performing a slightly different technique for the surgery. He was more confident in the success rate with this different technique. 

For what it's worth, my recovery time post surgery was closer to 3-4 months for light use, was back closer to full strength at 6-8 months. 

I liked Dr. Lodha and didn't feel like he pressured me into the surgery, more that he considered the situation and factored in my lifestyle into the recommendation.

I saw Dr. Lodha first too! agree - no pressure to do the surgery -  but he recommend at minimum to do the surgery within a couple years.  also said %80 success.  thanks for the input. glad to hear your out there climbing

hi @stu

 you so much for the insights. I am sorry first of all with all the injuries you've been through. I am 35M and post my TFCC arthroscopic surgery 6 months ago I'd still been feeling tingling and uneasiness pain on my right wrist when I used to slowly boulder. Now after a second MRT this winter, now it shows my SL Ligament is torn as well and theres bit of tendoniopathy on the ECU sheath. the pain is not unbearable as Physiotherapy and strength training has helped me. when I do warmup and wrist activation exercises it does help. I do some basic climbing at the gym but I'm unsure if it would be good to continue as the pain comes coming and going but nothing like a swelling or unbearable pain. did you do any other physiotherapy exercises for the natural healing of your SLL? so far I've been doing mobility and reverse wrist curls exercises.

I am hoping I don't go under the knife twice and am not sure if SLs heal themselves naturally. I thank you in advance for your time.

yes tried physical therapy for 6month - there was some improvement for day to day/work.  Climbing had no improvement -  i would test the waters occasionally with a light day out and the pain would come back fairly quickly.  There was others in the threads that had similar outcomes with physical therapy not helping.

I think the SL ligament the swelling is subtle after climbing days- that's my experience 

I just got stem cells injections into the whole wrist on 1/9 and still in recovery.  they say 1-6months before knowing if the procedure worked.   

hi stu - thanks a lot for your response, really appreciate it. I am doing foam rolling and a bit of therapy. my TFCC pain seems to be resolved but post small v2 v3 bouldering sessions "similar to you" the pain comes back "fairly quickly"   . luckily the pain is not so horrible and goes after 48 hours, surprisingly the foam rolling has been helping me a lot.
Thanks a lot about the stem cells info, I will check it here. Finding appointments with good hand surgeons here in Germany is also a hassle. I would keep doing small str training and hope eventually the scar tissue does heal without surgery. wishing you a speedy recovery too
LG