Advertisement

Arthroscopic Management of Lunotriquetral Ligament Tears

  • Michael J. Moskal
  • Felix H. SavoieIII
Chapter

Abstract

Lunotriquetral instability is treated based upon degree of instability and concomitant pathology although there is no consensus on treatment of lunotriquetral instability. Lunotriquetral instability, with or without concomitant pathology, has been surgically managed with arthrodesis, ligament graft reconstruction, ligament repair, percutaneous pinning, and ulnar shortening.

In this arthroscopic approach, management of lunotriquetral instability combines arthroscopic soft tissue management with arthroscopic reduction of the lunotriquetral joint and percutaneous pinning. Arthroscopic suture plication of the ulnocarpal ligaments shortens ligament length to act as a checkrein to excessive lunotriquetral motion similar to ligament tightening associated with ulnar shortening. Ligament plication with arthroscopic lunotriquetral reduction and pinning is useful for treatment while minimizing motion losses after surgery and reducing surgical exposure.

Keywords

Ulnar Variance Extensor Carpus Ulnaris Arthroscopic Evaluation Arthroscopic Reduction Ulnar Side Wrist Pain 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Kulick M, Chen C, Swearingen P. Determining the diagnostic accuracy of wrist arthroscopy. Toronto, ON: Annual meeting of the American Society for Surgery of the Hand; 1990.Google Scholar
  2. 2.
    Palmer C, Murray P, Snearly W. The mechanism of ulnar sided perilunate instability of the wrist. Toronto, ON: Annual meeting of the American Society for Surgery of the Hand; 1998.Google Scholar
  3. 3.
    Horii E, Gacias-Elias M, An K, et al. A kinematic study of lunato-triquetral dislocations. J Hand Surg Am. 1991;16A:355.CrossRefGoogle Scholar
  4. 4.
    Viegas S, Peterson P, et al. Ulnar-sided perilunate instability: An anatomic and biomechanical study. J Hand Surg Am. 1990;15A:268.CrossRefGoogle Scholar
  5. 5.
    Trumble T, Bour C, Smith R, et al. Kinematics of the ulnar carpus to the volar intercalated segment instability pattern. J Hand Surg Am. 1990;15A:384.CrossRefGoogle Scholar
  6. 6.
    Reagan D, Linscheid R, Dobyns J. Lunatotriquetral sprains. J Hand Surg Am. 1984;9A:502–14.CrossRefGoogle Scholar
  7. 7.
    Kleinman W. Physical examination of lunatotriquetral joint. Am Soc Surg Hand Corr Newsletter. 1985;51:74.Google Scholar
  8. 8.
    Kleinman W. Long-term study of chronic scapho-lunate instability treated by scapho-trapezio-trapezoid arthodesis. J Hand Surg Am. 1989;14A:429.CrossRefGoogle Scholar
  9. 9.
    Palmer A, Werner F. The triangular fibrocartilage complex of the wrist: anatomy and function. J Hand Surg Am. 1981;6:153.PubMedCrossRefGoogle Scholar
  10. 10.
    Palmer A. Triangular fibrocartilage complex lesions: a classification. J Hand Surg Am. 1989;14A:594.CrossRefGoogle Scholar
  11. 11.
    Palmer A, Glisson R, Werner F. Ulnar variance determination. J Hand Surg Am. 1982;7:376.PubMedCrossRefGoogle Scholar
  12. 12.
    Gilula L. Posteroanterior wrist radiography: importance of arm positioning. J Hand Surg Am. 1987;12A:504–8.Google Scholar
  13. 13.
    Hulten O. Uber anatomische variationen der hand-Gelenkknochen. Acta Radiol. 1928;9:155.CrossRefGoogle Scholar
  14. 14.
    Steyers C, Blair W. Measuring ulnar variance: a comparison of techniques. J Hand Surg Am. 1989;14A:607.CrossRefGoogle Scholar
  15. 15.
    Gilula L. Carpal injuries: analytic approach and case exercises. AJR Am J Roentgenol. 1979;133:503–17.PubMedCrossRefGoogle Scholar
  16. 16.
    Bednar J, Osterman A. Carpal instability: evaluation and treatment. J Am Acad Orthop Surg. 1993;1:10–7.PubMedGoogle Scholar
  17. 17.
    Cooney W, Dobyns J, Linscheid R. Arthroscopy of the wrist: anatomy and classification of carpal instability. Arthroscopy. 1990;6:113–40.CrossRefGoogle Scholar
  18. 18.
    Mayfield J. Patterns of injury to carpal ligaments: a spectrum. Clin Orthop. 1984;187:36.PubMedGoogle Scholar
  19. 19.
    Werner F, Palmer A, Fortino M, et al. Force transmission through the distal ulna: effect of ulnar variance, lunate fossa angulation, and radial and palmar tilt of the distal radius. J Hand Surg Am. 1992;17A:423.CrossRefGoogle Scholar
  20. 20.
    Melone Jr C, Nathan R. Traumatic disruption of the triangular fibrocartilage complex, pathoanatomy. Clin Orthop. 1992;275:65–73.PubMedGoogle Scholar
  21. 21.
    Green D. Carpal dislocation and instabilities. In: Green D, editor. Operative hand surgery. New York, NY: Churchill Livingston; 1988. p. 878–9.Google Scholar
  22. 22.
    Palmer A, Werner F. Biomechanics of the distal radioulnar joint. Clin Orthop. 1984;187:26.PubMedGoogle Scholar
  23. 23.
    Garcias-Elias M, Domenech-Mateu J. The articular disc of the wrist: limits and relations. Acta Anat. 1987;128:51.CrossRefGoogle Scholar
  24. 24.
    Johnson R, Carrera G. Chronic capitolunate instability. J Bone Joint Surg. 1986;68A:1164–76.Google Scholar
  25. 25.
    Viegas S, Wagner K, Patterson R, et al. Medial (hamate) facet of the lunate. J Hand Surg Am. 1990;15A:564–71.CrossRefGoogle Scholar
  26. 26.
    Pin P, Young V, Gilula L, et al. Management of chronic lunatotriquetral ligament tears. J Hand Surg Am. 1989;14A:77–83.CrossRefGoogle Scholar
  27. 27.
    Osterman A, Sidman G. The role of arthroscopy in the treatment of lunatotriquetral ligament injuries. Hand Clin. 1995;11:41–50.PubMedGoogle Scholar
  28. 28.
    Seradge H, Sterbank P, Seradge E, et al. Segmental motion of the proximal carpal row: their global effect on the wrist motion. J Hand Surg Am. 1990;15A:236–9.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Orthopaedic Surgery DepartmentUniversity of LouisvilleSellersburgUSA
  2. 2.Department of OrthopaedicsTulane University School of MedicineNew OrleansUSA

Personalised recommendations