Abstract
Purpose of Review
The standard of care for lunotriquetral ligament injuries is evolving. An understanding of the mechanics of the lunotriquetral ligament and its role in carpal kinematics is critical when deciding how to treat these injuries. Treatment for these injuries varies from nonoperative to wrist arthroscopy with thermal capsulodesis and/or repair to reconstruction or limited arthrodesis. This article provides a review of the anatomy, pathomechanics, evaluation, and ultimately treatment of lunotriquetral ligament injuries.
Recent Findings
Although lunotriquetral ligament injuries can occur in isolation, injuries to the lunotriquetral ligament are often viewed as a component of other injury patterns to the intrinsic and extrinsic ligaments of the wrist. Static volar intercalated segment instability typically occurs when the dorsal radiocarpal ligament is also compromised. If nonoperative treatment fails, arthroscopy is the gold standard for diagnosis even with improving imaging modalities. Recently, authors have proposed employing the technique of ulnar-shortening osteotomy in those with ulnar negative variance and the absence of an impaction lesion. Other newer techniques included bone-ligament-bone reconstruction for chronic, static instability.
Summary
LT injuries rarely occur in isolation. Most injuries involving the lunotriquetral ligament can be treated nonoperatively. Those individuals with persistent pain should be treated with a diagnostic wrist arthroscopy. Primary repairs are indicated in those with an acute, complete tear. In chronic, static instability, ligament reconstruction has been shown to improve wrist function and decrease pain.
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References
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Ritt MJ, Linscheid RL, Cooney WP III, Berger RA, An KN. The lunotriquetral joint: kinematic effects of sequential ligament sectioning, ligament repair, and arthrodesis. J Hand Surg. 1998;23(3):432–45.
Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg. 1980;5(3):226–41.
Melone CP Jr, Nathan R. Traumatic disruption of the triangular fibrocartilage complex. Pathoanatomy. Clin Orthop Relat Res. 1992;1(275):65–73.
Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg. 1984;9(4):502–14.
Romaniuk CS, Butt WP, Coral A. Bilateral three-compartment wrist arthrography in patients with unilateral wrist pain: findings and implications for management. Skelet Radiol. 1995;24(2):95–9.
Magee T. Comparison of 3-T MRI and arthroscopy of intrinsic wrist ligament and TFCC tears. Am J Roentgenol. 2009;192(1):80–5.
Asaad AM, Andronic A, Newby MP, Harrison JW. Diagnostic accuracy of single-compartment magnetic resonance arthrography in detecting common causes of chronic wrist pain. J Hand Surg Eur Vol. 2017;42(6):580–5.
Viegas SF, Patterson RM, Peterson PD, Pogue DJ, Jenkins DK, Sweo TD, Hokanson JA. Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg. 1990;15(2):268–78.
Geissler WB, Freeland AE, Savoie FH, McINTYRE LW, Whipple TL. Intracarpal soft-tissue lesions associated with an intra-articular fracture of the distal end of the radius. JBJS. 1996;78(3):357–65.
Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg. 1997;22(2):344–9.
Osterman AL, Seidman GD. The role of arthroscopy in the treatment of lunatotriquetral ligament injuries. Hand Clin. 1995;11(1):41-50. The authors critically evaluated 20 consecutive patients treated with arthroscopic debridement, reduction, and pinning of the LT joint. The authors found an 80% success rate with this treatment algorithm.
Berger RA, Bishop AT. A fiber-splitting capsulotomy technique for dorsal exposure of the wrist. Tech Hand Upper Extrem Surg. 1997;1(1):2–10.
Shin AY, Weinstein LP, Berger RA, Bishop AT. Treatment of isolated injuries of the lunotriquetral ligament. A comparison of arthrodesis, ligament reconstruction and ligament repair. J Bone Joint Surg Br. 2001;83(7):1023-8. This comparative study evaluated 57 patients treated with LT repair, reconstruction, or arthrodesis. The study shows that those individuals who underwent repair or reconstruction had higher rates of satisfaction and those who underwent reconstruction were least likely to require further surgery at 5 years.
Shin AY, Bishop AT. Treatment options for lunotriquetral dissociation. Tech Hand Upper Extrem Surg. 1998;2(1):2–17.
Harper CM, Iorio ML. Lunotriquetral ligament reconstruction utilizing a palmaris longus autograft. J Hand Surg Asian Pac Vol. 2017;22(04):544–7.
Riederer JM, Adler T, Vögelin E, Haug L. Dorsal bone-ligament-bone reconstruction of chronic lunotriquetral instability: biomechanical testing. J Hand Surg Glob Online. 2020;3(1):47-55. This article discusses the biomechanical properties of reconstruction of the LT ligament and assesses the adjacent joint motion patterns as compared to LT arthrodesis.
Sennwald GR, Fischer M, Mondi P. Lunotriquetral arthrodesis. A controversial procedure. J Hand Surg Br. 1995;20(6):755–60.
Guidera PM, Watson HK, Dwyer TA, Orlando G, Zeppieri J, Yasuda M. Lunotriquetral arthrodesis using cancellous bone graft. J Hand Surg. 2001;26(3):422–7.
Van de Grift TC, Ritt MJ. Management of lunotriquetral instability: a review of the literature. J Hand Surg Eur Vol. 2016;41(1):72-85. This review articles provides a comprehensive review of the pathoanatomy of lunotriquetral ligament injuries and the efficacy of treatment in those who fail nonoperative management.
Gupta R, Bingenheimer E, Fornalski S, McGarry MH, Osterman AL, Lee TQ. The effect of ulnar shortening on lunate and triquetrum motion—a cadaveric study. Clin Biomech. 2005;20(8):839–45.
Mirza A, Mirza JB, Shin AY, Lorenzana DJ, Lee BK, Izzo B. Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy. J Hand Surg. 2013;38(8):1492–7.
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Wilson, M.S. Diagnosis and Management of Lunotriquetral Ligament Injuries. Curr Rev Musculoskelet Med 16, 55–59 (2023). https://doi.org/10.1007/s12178-022-09819-7
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DOI: https://doi.org/10.1007/s12178-022-09819-7