HAND

, Volume 7, Issue 4, pp 413–419 | Cite as

Anatomic reconstruction of the radioulnar ligament

Surgery Articles
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Abstract

Introduction

Twenty-five patients (19 males and six females) were included in the study based on: chronic symptoms of distal radioulnar joint instability, demonstrable instability on examination, MRI evidence of radioulnar ligament deficiency, and arthroscopic findings of foveal disruption of the radioulnar ligament.

Materials and Methods

Exclusion criteria were: distal radius malunion, congenital malformation of the sigmoid notch, DRUJ arthritis, and less than 24 months minimum follow-up. Mean age was 35 years old with a mean interval from injury to surgery of 5 months. Surgery began with arthroscopic confirmation of the chronic foveal detachment followed by open reconstruction of the radioulnar ligament using the palmaris longus tendon. The specific method employed three drill tunnels corresponding to the true anatomic points of attachment of the radioulnar ligament. Patients were examined post-operatively at 2 weeks, 4 weeks, 6 weeks, 12 weeks, and 6 months.

Results and Discussion

Final evaluation averaged 51 (±14) months following surgery. Measures obtained before and after treatment included: wrist range of motion, forearm range of motion, grip strength, examination findings of distal radioulnar joint instability, and Disabilities of Arm, Shoulder, and Hand (DASH) scores. Pre-operative and post-operative measures were compared using the paired Student’s t test, accepting a p value of 0.05 as statistically significant. All patients healed the reconstruction without major complications and demonstrated distal radioulnar joint stability at the 6-week examination. Mean ranges of motion, in degrees, pre-/post-operative were: wrist flexion 53 (±13)/61 (±10), wrist extension 53 (±13)/62 (±15), supination 65 (±12)/74 (±7), and pronation 66 (±11)/71 (±8). Grip strengths expressed as % contralateral pre-/post-operative were: 57 (±23)/79 (±25). The differences in these measures were not found to be statistically significant. The mean pre-/post-operative DASH scores were: 62 (±16)/7 (±3). This difference was found to be statistically significant.

Conclusion

Reconstruction of the RUL with a free palmaris longus tendon graft using the truly anatomic points of original RUL attachment at both the ulna and radius restored DRUJ stability and improved DASH scores without limiting forearm or wrist motion.

Keywords

DRUJ Radioulnar ligament Reconstruction 

References

  1. 1.
    Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg. 2002;27:243–51.CrossRefGoogle Scholar
  2. 2.
    Blazar PE, Chan PS, Kneeland JB, et al. The effect of observer experience on magnetic resonance imaging interpretation and localization of triangular fibrocartilage complex lesions. J Hand Surg. 2001;26:742–8.CrossRefGoogle Scholar
  3. 3.
    DiTano O, Trumble TE, Tencer AF. Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments. J Hand Surg. 2003;28:622–7.CrossRefGoogle Scholar
  4. 4.
    Gofton WT, Gordon KD, Dunning CE, et al. Comparison of distal radioulnar joint reconstructions using an active joint motion simulator. J Hand Surg. 2005;30:733–42.CrossRefGoogle Scholar
  5. 5.
    Haugstvedt JR, Berger RA, Nakamura T, et al. Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg. 2006;31:445–51.CrossRefGoogle Scholar
  6. 6.
    Henry MH. TFCC—a DRUJ perspective. In: del Pinal F, editor. Arthroscopic management of ulnar pain. New York: Springer; 2012.Google Scholar
  7. 7.
    Henry MH. Management of acute triangular fibrocartilage complex injury of the wrist. J Am Acad Orthop Surg. 2008;16:320–9.PubMedGoogle Scholar
  8. 8.
    Henry MH, Smith DW, Masson MV. Reconstruction of distal radioulnar joint instability. J Am Soc Surg Hand. 2004;4:35–41.CrossRefGoogle Scholar
  9. 9.
    Kato H, Nakamura R, Shionoya K, et al. Does high-resolution MR imaging have better accuracy than standard MR imaging for evaluation of the triangular fibrocartilage complex? J Hand Surg. 2001;26B:502–3.Google Scholar
  10. 10.
    Kihara H, Short WH, Werner FW, et al. The stabilizing mechanism of the distal radioulnar joint during pronation and supination. J Hand Surg. 1995;20:930–6.CrossRefGoogle Scholar
  11. 11.
    Martineau PA, Bergeron S, Beckman L, et al. Reconstructive procedure for unstable radial-sided triangular fibrocartilage complex avulsions. J Hand Surg. 2005;30:727–32.CrossRefGoogle Scholar
  12. 12.
    Nakamura T, Takayama S, Horiuchi Y, et al. Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg. 2001;26B:446–54.Google Scholar
  13. 13.
    Schuind F, An KN, Berglund L, et al. The distal radioulnar ligaments: a biomechanical study. J Hand Surg. 1991;16:1106–14.CrossRefGoogle Scholar
  14. 14.
    Shih JT, Lee HM. Functional results post-triangular fibrocartilage complex reconstruction with extensor carpi ulnaris with or without ulnar shortening in chronic distal radioulnar joint instability. Hand Surg. 2005;10:169–76.PubMedCrossRefGoogle Scholar
  15. 15.
    Slutsky DJ. Distal radioulnar joint arthroscopy and the volar ulnar portal. Tech Hand Up Extrem Surg. 2007;11:38–44.PubMedCrossRefGoogle Scholar
  16. 16.
    Slutsky DJ. Arthroscopic evaluation of the foveal attachment of the triangular fibrocartilage. Hand Clin. 2011;27:255–61.PubMedCrossRefGoogle Scholar
  17. 17.
    Stuart PR, Berger RA, Linscheid RL, et al. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg. 2000;25:689–99.CrossRefGoogle Scholar
  18. 18.
    Tanaka T, Yoshioka H, Ueno T, et al. Comparison between high-resolution MRI with a microscopy coil and arthroscopy in triangular fibrocartilage complex injury. J Hand Surg. 2006;31:1308–14.CrossRefGoogle Scholar
  19. 19.
    Teoh LC, Yam AK. Anatomic reconstruction of the distal radioulnar ligaments: long-term results. J Hand Surg. 2005;30B:185–93.Google Scholar
  20. 20.
    Watanabe H, Berger RA, Berglund LJ, et al. Contribution of the interosseous membrane to distal radioulnar joint constraint. J Hand Surg. 2005;30:1164–71.CrossRefGoogle Scholar
  21. 21.
    Xu J, Tang JB. In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint. J Hand Surg. 2009;34:40–5.Google Scholar

Copyright information

© American Association for Hand Surgery 2012

Authors and Affiliations

  1. 1.Hand and Wrist Center of HoustonHoustonUSA

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