LT Tears and Arthroscopic Repair

Abstract

An injury of the LT lig is thought of being the result of a fall on an outstretched hand where the hand has been forcefully twisted into extension, radial deviation, and pronation, thus displacing the triquetrum dorsally relative to the lunate. The palmar region of the LT lig is the thickest and strongest region of this interosseous ligament. Due to the secondary joint stabilizers of the LT joint, a true static instability, or VISI, is very rare, and most of the LT lig injuries are found to be dynamic.

The patient presents with an ulnar-sided wrist pain; the symptoms, however, are often intermittent and are prominent in special positions of the wrist such as ulnar deviation or pronation. Upon clinical examination, the proximal row squeeze (PRS) test will reproduce the patient’s pain on the dorsal, ulnar aspect of the wrist as the triquetrum slides distally on the ulnar slope of the lunate due to disruption of the LT lig. Radiographs may in some cases show disruption of Gilula’s lines, or a VISI pattern. Arthrography or an MRI could also indicate a ligament injury. Arthroscopy, however, should be considered the gold standard for examining the wrist and diagnosing wrist ligament injuries.

Treatment of an LT lig injury could be performed by arthroscopic debridement of the ligament tear, arthroscopically assisted reposition of the bones to correct alignment, and fixation of the bones by multiple pinning in order to create a fibrodesis across the LT interval. Other treatment options should be considered when debridement and LT pin fixation fail or when a chronic instability is diagnosed with a carpal collapse. These options include ligament reconstruction, capsulodesis, tenodesis, or arthrodesis.