Arthroscopic-assisted radiocarpal ligaments tensioning for dynamic radiocarpal instability

Abstract

Background Dynamic radiocarpal instability is one of the causes of post-trauma radial-sided wrist pain. It is not easy to diagnose and may possibly be overlooked. The key ligaments responsible for dynamic radiocarpal instability are the radioscaphocapitate (RSC) and long radiolunate (LRL) ligaments. Tensioning of these 2 ligaments could be a method of treatment for dynamic carpal instability. We proposed a method for arthroscopic thermal shrinkage of these 2 ligaments, and for setting a landmark arthroscopically to facilitate identification of these 2 ligaments during the combined open suture tensioning procedure. Methods Between January 2016 and May 2020, 12 patients treated with this method were enrolled. The mean age was 33.3 years (range, 18–57 years), and the mean duration from injury to operation was 7.8 months (range, 3–25 months). The diagnosis was mainly depended on the physical examinations and confirmed under arthroscopy. The mean follow-up was 17.7 months (range, 12–26 months). Results All the patients had marked improvement of pain, grip strength, the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and the radiocarpal stability. The wrist range of motion showed significant decrease around 5o in both flexion and extension and around 4o in the ulnar deviation at the final follow-ups. All patients were able to return to their previous full level of work and activities. Conclusions We conclude that arthroscopic thermal shrinkage combined with open suture tensioning can be effective in treating dynamic carpal instability, while the arthroscopic-assisted landmark setting can help identify the accurate location of the RSC and LRL ligaments without dissecting too much soft tissue.

Arthroscopical Reinforcement of an Isolated Insufficiency of the Radioscaphocapitate Ligament to Treat Dynamic Radioscaphoid Instability: A Case Report

“…9 Although thermal shrinkage is also believed to facilitate ligament strengthening, this reinforcement by suture possibly provides more tightening compared with thermal shrinkage. 10,11 Additionally, the suture induces a fibrotic healing that probably will enhance the stability on the longer term. Esenyel et al demonstrated that nonabsorbable suture materials induces capsular reaction, with most of the inflammatory reaction in the first 3 to 4 weeks.…”

Total Wrist Replacement: State of the Art, Challenges and Pitfalls: A Comparative Review

“…as well that a radial styloid resection should be performed only distal to the origin of the radioscaphocapitate ligament (i.e. level A) to avoid instability of the wrist presented as radial wrist pain and/or ulnar carpal (prosthetic) dislocation tendency [52,71,72]. A novel approach in order to enhance the stability of the radial-sided screw could be cement augmentation of it.…”