Skip to main content

Advertisement

SpringerLink
Log in

The optimal tension for the reconstruction of the distal radioulnar ligaments

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to investigate the optimal tension for the reconstruction of the distal radioulnar ligaments (DRULs) in the treatment of the distal radioulnar joint (DRUJ) instability.

Methods

A total of eight human cadaver upper extremities were used. First, the Tekscan sensor film system was used to measure the contact characteristics of the intact DRUJ. Following this, the DRULs were resected, and the measurement was repeated. The DRULs were then reconstructed according to Adams’ procedure, and the contact forces under different initial tension were compared with that of the intact group to obtain the optimal tension. At that point, the contact force of the DRUJ was close to normal. The reliability of the obtained tension was verified by translational testing, which reflected the stability of the DRUJ.

Results

In the neutral position, the contact force, area, and pressure inside DRUJ were 0.51 ± 0.10 N, 64.08 ± 11.58 mm2, and 8.33 ± 2.42 kPa, respectively. After the DRULs were resected, they were 0.19 ± 0.02 N, 41.75 ± 5.01 mm2, and 4.86 ± 1.06 kPa, respectively. The relationship between the tension and contact force was linear regression (Y = 0.0496x + 0.229, R2 = 0.9575, P < 0.0001). According to the equation, when the tension was 3.64–7.68 N, the contact force was close to normal. There was no statistical difference in the stability of the reconstructed DRUJ under this tension compared with the intact group (P = 0.08).

Conclusion

By comparing the contact forces under different reconstruction tensions with the normal value, we obtained the optimal tension, which can provide the theoretical basis for the clinical treatment of chronic DRUJ instability.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Kleinman WB (2007) Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg Am 32:1086–1106. https://doi.org/10.1016/j.jhsa.2007.06.014

    Article  PubMed  Google Scholar 

  2. Haugstvedt JR, Berger RA, Nakamura T, Neale P, Berglund L, An KN (2006) Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg Am 31:445–451. https://doi.org/10.1016/j.jhsa.2005.11.008

    Article  PubMed  Google Scholar 

  3. Spies CK, Langer MF, Muller LP, Unglaub F (2020) Reconstruction of the deep fibers of the distal radioulnar ligaments facilitating a tendon graft-Adams’ procedure. Oper Orthop Traumatol 32:262–270. https://doi.org/10.1007/s00064-019-00638-7

    Article  PubMed  Google Scholar 

  4. Sakakibara Y, Teramoto A, Takagi T, Yamakawa S, Shoji H, Okada Y, Kobayashi T, Kamiya T, Fujimiya M, Fujie H, Watanabe K, Yamashita T (2020) Effect of initial graft tension during anterior talofibular ligament reconstruction on ankle kinematics, laxity, and in situ forces of the reconstructed graft. Am J Sports Med 48:916–922. https://doi.org/10.1177/0363546520902725

    Article  PubMed  Google Scholar 

  5. Chu-Kay Mak M, Ho PC (2017) Arthroscopic-assisted triangular fibrocartilage complex reconstruction. Hand Clin 33:625–637. https://doi.org/10.1016/j.hcl.2017.07.014

    Article  PubMed  Google Scholar 

  6. Luchetti R, Atzei A (2017) Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears. J Hand Surg Eur 42:346–351. https://doi.org/10.1177/1753193417690669

    Article  CAS  Google Scholar 

  7. Shaaban H, Giakas G, Bolton M, Williams R, Wicks P, Scheker LR, Lees VC (2007) Contact area inside the distal radioulnar joint: effect of axial loading and position of the forearm. Clin Biomech (Bristol, Avon) 22:313–318. https://doi.org/10.1016/j.clinbiomech.2006.05.010

    Article  CAS  Google Scholar 

  8. Gammon B, Lalone E, Nishiwaki M, Willing R, Johnson J, King GJW (2019) The effect of dorsal angulation on distal radioulnar joint arthrokinematics measured using intercartilage distance. J Wrist Surg 8:10–17. https://doi.org/10.1055/s-0038-1667303

    Article  PubMed  Google Scholar 

  9. Miura T, Firoozbakhsh K, Cheema T, Moneim MS, Edmunds M, Meltzer S (2005) Dynamic effects of joint-leveling procedure on pressure at the distal radioulnar joint. J Hand Surg Am 30:711–718. https://doi.org/10.1016/j.jhsa.2005.03.007

    Article  PubMed  Google Scholar 

  10. Nishiwaki M, Nakamura T, Nagura T, Toyama Y, Ikegami H (2008) Ulnar-shortening effect on distal radioulnar joint pressure: a biomechanical study. J Hand Surg Am 33:198–205. https://doi.org/10.1016/j.jhsa.2007.11.024

    Article  PubMed  Google Scholar 

  11. Liu B, Fok MWM (2021) The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal reconstruction using tendon graft. Int Orthop 45:1273–1279. https://doi.org/10.1007/s00264-021-04976-9

    Article  PubMed  Google Scholar 

  12. Carlson GD, Botte MJ, Josephs MS, Newton PO, Davis JL, Woo SL (1993) Morphologic and biomechanical comparison of tendons used as free grafts. J Hand Surg Am 18:76–82. https://doi.org/10.1016/0363-5023(93)90249-3

    Article  CAS  PubMed  Google Scholar 

  13. Gammon B, Lalone E, Nishiwaki M, Willing R, Johnson J, King GJW (2018) Arthrokinematics of the distal radioulnar joint measured using intercartilage distance in an in vitro model. J Hand Surg Am 43:283 e281-283 e289. https://doi.org/10.1016/j.jhsa.2017.08.010

    Article  Google Scholar 

  14. Lapner PC, Poitras P, Backman D, Giachino AA, Conway AF (2004) The effect of the wafer procedure on pressure in the distal radioulnar joint. J Hand Surg Am 29:80–84. https://doi.org/10.1016/j.jhsa.2003.10.012

    Article  PubMed  Google Scholar 

  15. Malone PS, Cooley J, Morris J, Terenghi G, Lees VC (2015) The biomechanical and functional relationships of the proximal radioulnar joint, distal radioulnar joint, and interosseous ligament. J Hand Surg Eur 40:485–493. https://doi.org/10.1177/1753193414532807

    Article  CAS  Google Scholar 

  16. DiTano O, Trumble TE, Tencer AF (2003) Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments. The Journal of Hand Surgery 28:622–627. https://doi.org/10.1016/s0363-5023(03)00183-7

    Article  PubMed  Google Scholar 

  17. Koga H, Muneta T, Yagishita K, Watanabe T, Mochizuki T, Horie M, Nakamura T, Otabe K, Sekiya I (2015) Effect of initial graft tension on knee stability and graft tension pattern in double-bundle anterior cruciate ligament reconstruction. Arthroscopy 31:1756–1763. https://doi.org/10.1016/j.arthro.2015.03.012

    Article  PubMed  Google Scholar 

  18. Kirwan GW, Bourke MG, Chipchase L, Dalton PA, Russell TG (2013) Initial graft tension and the effect on postoperative patient functional outcomes in anterior cruciate ligament reconstruction. Arthroscopy 29:934–941. https://doi.org/10.1016/j.arthro.2013.01.021

    Article  PubMed  Google Scholar 

  19. Meyer D, Schweizer A, Nagy L (2017) Anatomic reconstruction of distal radioulnar ligaments with tendon graft for treating distal radioulnar joint instability: surgical technique and outcome. Tech Hand Up Extrem Surg 21:107–113. https://doi.org/10.1097/bth.0000000000000163

    Article  PubMed  Google Scholar 

  20. Matsumoto T, Tang P, Fujio K, Strauch RJ, Rosenwasser MP (2018) The optimal suture placement and bone tunnels for TFCC repair: a cadaveric study. J Wrist Surg 7:375–381. https://doi.org/10.1055/s-0038-1661361

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kataoka T, Moritomo H, Omokawa S, Iida A, Wada T, Aoki M (2013) Palmar reconstruction of the triangular fibrocartilage complex for instability of the distal radioulnar joint: a biomechanical study. J Hand Surg Eur 38:515–522. https://doi.org/10.1177/1753193412461743

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank Tong Zhou from Shanghai Blackflame Medical Technology Co., Ltd., for his assistance.

Funding

This study was supported by Wuxi “Taihu Talent Plan” high-level medical and health talents.

Author information

Author notes

  1. Fengming Gu and Jinquan Liu have the same contribution to this manuscript and are the co-first author of this paper.

Authors and Affiliations

  1. Department of Orthopaedics, Wuxi 9Th People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China

    Fengming Gu, Jinquan Liu, Lutian Liao & Xiaodong Fang

  2. Department of Sports Medicine, Wuxi 9Th People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China

    Fei Xiong & Jingyi Mi

  3. Orthopaedic Institute, Wuxi 9Th People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China

    Xiaoyun Pan

  4. Department of Hand Surgery, Wuxi 9Th People’s Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China

    Gang Zhao

Authors
  1. Fengming Gu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jinquan Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lutian Liao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaodong Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Fei Xiong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiaoyun Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jingyi Mi
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors (FMG, JQL, LTL, XDF, FX, XYP, GZ, and JYM) contributed to the study conception and design. Material preparation, data collection, and analysis were performed by FMG, JQL, LTL, XDF, FX, XYP, and GZ. The first draft of the manuscript was written by FMG and critically revised by JYM. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jingyi Mi.

Ethics declarations

Ethics approval

The study was approved by the Ethics Committee of Wuxi 9th People’s Hospital Affiliated to Soochow University.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

ESM 1

(PNG 287 kb)

Supplementary file1 (TIF 27871 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gu, F., Liu, J., Liao, L. et al. The optimal tension for the reconstruction of the distal radioulnar ligaments. International Orthopaedics (SICOT) 46, 2283–2289 (2022). https://doi.org/10.1007/s00264-022-05525-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-022-05525-8

Keywords

Search

Navigation