Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up

Helsper, Elizabeth; Frantz, Lisa M; Adams, Jessica; Morris, Harry A.; Hearon, Bernard F.

doi:10.1177/1753193420927882

Cited by 6 publications

(8 citation statements)

References 33 publications

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“…Fifth, we did not assess patients for TFCC injury by magnetic resonance imaging or arthroscopic exam [ 42 ], and we did not directly explore the DIOM as we didn’t intend to perform DRUJ reconstruction in the acute stage of DRUJ instability. Sixth, there was no direct biomechanical evidence to prove that tightening the DOB alone in DRFs with intraoperative DRUJ instability could restore stability, and increased tension in other DRUJ stabilizers, including ulnocarpal ligaments, DRUJ capsule, and superficial radioulnar ligaments [ 43 ], resulting from radius distraction could also be indirectly responsible for improving DRUJ stability. Meanwhile, we have to point out that there were some innate limitations of this surgical technique to affect the generalized application to every DRF with intraoperative DRUJ instability.…”

Section: Discussionmentioning

confidence: 99%

Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study

Yin

Huang

Fufa

et al. 2022

BMC Musculoskelet Disord

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Background The surgical technique of radius distraction for stabilization of distal radioulnar joint (DRUJ) if intraoperative DRUJ instability was found after the fixation of distal radius fracture has been previously described, but this surgical technique lacks clinical and radiographic effect in minimal 3 years follow-up. We therefore evaluated the clinical outcome and radiographic results of radius distraction in minimal 3 years follow-up as long-term evaluation. Methods We reviewed the case series of distal radius fracture with concomitant DRUJ instability receiving radius distraction from the senior author over a 5-year period (January 1st, 2013, to June 30th, 2017) retrospectively. Radius distraction during volar plating was performed by moving the volar plate distally via compression screw loosening/fastening to achieve firm endpoint on the dorsopalmar stress test. The evaluations of radiographic, including bone union time and ulnar variance, and clinical outcomes, including grading of DRUJ instability, NRS of wrist pain, DASH score, MMWS score, and range of motion of operated wrist at final follow-up, were performed at clinic as minimum 3-year follow-up; a total 34 patients had been evaluated. Results At minimal post-operative 36 months follow-up, all cases demonstrated acceptable wrist range of motion with stable DRUJs, low NRS of wrist pain (0.6, SD 0.7), and satisfactory DASH score (mean 9.1, SD 6.2) and MMWS score (mean 87, SD 10). There were no cases suffering from nonunion of distal radius. The mean ulnar variance of injured wrist and uninjured wrist were -1.2 mm and 0.2 mm, respectively (SD 1.0 and 0.6) with significant statistical difference. Conclusions Radius distraction during volar fixation of distal radius fracture should be considered if DRUJ instability was found by the dorsopalmar stress test intraoperatively, and the long-term DRUJ stability could be achieved by maintenance of normal-to-negative ulnar variance, with decreased wrist pain and satisfactory function outcome. Level of Evidence Therapeutic Level IV

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Section: Discussionmentioning

confidence: 99%

Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study

Yin

Huang

Fufa

et al. 2022

BMC Musculoskelet Disord

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“…30 Owing to concerns about suboptimal outcomes from TFCC repairs in our practice, patients in this study were offered arthroscopic thermal annealing of the secondary DRUJ stabilizers for chronic instability, regardless of severity, as an alternative to open treatment. 11 Targeting the superficial radioulnar and ulnocarpal ligaments as well as the dorsoulnar wrist capsule with heat energy using a radiofrequency probe produces contraction of those structures and observable narrowing of the ulnocarpal joint. Postoperative immobilization permits soft tissue healing in the contracted position, thereby increasing tension in the secondary DRUJ stabilizers which, though stretched or partially torn, remain somewhat in continuity.…”

Section: Discussionmentioning

confidence: 99%

“…Since 1998, arthroscopic thermal annealing of the secondary capsuloligamentous DRUJ stabilizers was offered to those presenting with chronic DRUJ instability as an alternative to open surgical treatment. 11 Under 10 to 15 lb (5-7 kg) of vertical wrist traction, radiocarpal inspection with a 2.9 mm 30-degree arthroscope was accomplished through the 3-4 viewing portal. Through the 6R portal, thermal energy was delivered by the Vulcan Micro TAC-S monopolar radiofrequency probe (Smith & Nephew, Inc., Andover, MA) to target tissues, including the superficial dorsal and palmar radioulnar, short radiolunate, ulnolunate, and ulnotriquetral ligaments and the dorsoulnar wrist capsule.…”

Section: Treatment Protocolsmentioning

confidence: 99%

“…Outcomes of our treatment cohorts have been reported in detail elsewhere. [10][11][12] In this study, the goals are to provide the demographic profile and clinical features of our entire patient cohort, to summarize our long-term key outcome measures of wrist pain and DRUJ stability, to determine overall patient satisfaction, and to identify treatment failures, adverse events, and the need for secondary procedures. Our approach to these patients is summarized in a new treatment algorithm providing management guidelines based on the acuity and severity of the instability.…”

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confidence: 99%

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Experience with Diagnosis and Management of Distal Radioulnar Joint Instability

et al. 2021

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Objective The aim of this study is to review our cumulative experience with diagnosis and treatment of distal radioulnar joint (DRUJ) instability and to present our treatment algorithm. Materials and Methods Retrospective review identified 112 patients who had 126 episodes of care for DRUJ instability at a single institution over a 21-year period. Those diagnosed acutely or subacutely were treated with immobilization of the wrist and elbow for 6 weeks, while those with chronic instability had anatomic reconstruction of the dorsal and palmar radioulnar ligaments with tendon autograft or an alternative arthroscopic treatment with our thermal annealing technique. Short-term treatment failures and surgical complications were recorded. Nonparametric statistical tests were used to analyze key long-term outcome measures including ulnar wrist pain and DRUJ stability indicated by the dorsopalmar stress test. Results At mean 7-year follow-up, eight patients in the acute-injury cohort had statistically significant improvements in wrist pain and DRUJ instability (p < 0.001). In both the 22-patient anatomic reconstruction cohort and the 37-patient arthroscopically treated group, there were also statistically significant improvements in wrist pain and DRUJ stability (p < 0.001) at mean 9-year follow-up. The majority of patients in all three groups was satisfied with treatment outcome, though some required secondary procedures. Conclusion Early clinical diagnosis of DRUJ instability using the dorsopalmar stress test provides an opportunity for effective nonsurgical treatment. For chronic presentation, we recommend our arthroscopic thermal annealing technique for mild or moderate instability and open anatomic reconstruction of the radioulnar ligaments for severe instability. Level of Evidence This is a Level IV, therapeutic study.

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“…Due to the feasibility of postoperative immobilization, the technique was trialed in smaller joints such as the ankle and wrist including SLL injuries. While results have varied for other pathology, 18 19 20 the management of partial SLL injuries with thermal shrinkage has demonstrated good results. 9 10 21 22 23 24…”

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confidence: 99%

Clinical Outcomes of Arthroscopic Ligament-Sparing Dorsal Capsulodesis for Partial Scapholunate Ligament Tear

et al. 2022

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Introduction Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tightening yields reliable and satisfactory results for the management of partial SLL tears. Methods A prospective cohort study was conducted on adult (age ≥18 years) patients with chronic partial SLL tears. All patients failed a trial of conservative management consisting of scapholunate strengthening exercises. Patients underwent an arthroscopic dorsal capsular tightening of the radiocarpal joint capsule radial to the origin of the dorsal radiocarpal ligament and proximal to the dorsal intercarpal ligament by either thermal shrinkage or dorsal capsule abrasion. Demographic data, radiological outcomes, patient-rated outcome measures and objective measures of wrist range of motion (ROM), and grip and pinch strength were recorded. Postoperative outcome scores were collected at 3, 6, 12, and 24 months. Data are reported as median and interquartile range, and comparisons were drawn between baseline and last follow-up. Clinical outcome data were analyzed using a linear mixed model method, while radiographic outcomes were assessed with nonparametric analysis with p < 0.05 indicating statistical significance. Results Twenty-three wrists (22 patients) underwent SLL treatment by thermal capsular shrinkage (19 wrists) or dorsal capsular abrasion (4 wrists). Median age at surgery was 41 years (range: 32–48) and median follow-up time was 12 months (range: 3–24). Pain significantly decreased from 62 (45–76) to 18 (7–41) and satisfaction significantly increased from 2 (0–24) to 86 (52–92). Patient-Rated Wrist and Hand Evaluation and Quick Disabilities of the Arm, Shoulder, and Hand significantly improved from 68 (38–78) to 34 (13–49) and from 48 (27–55) to 36 (4–58), respectively. Median grip and tip pinch strength significantly increased at final review. Range of movement and lateral pinch strength were satisfactory and maintained. Four patients required further surgery for ongoing pain or reinjury. All were successfully managed with partial wrist fusion or wrist denervation. Conclusion Arthroscopic ligament-sparing dorsal capsular tightening is a safe and effective treatment for partial SLL tears. Dorsal capsular tightening demonstrates good pain relief and patient satisfaction while improving patient-reported outcomes, grip strength, and maintaining ROM. Longer term studies are required to determine the longevity of these results.

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Arthroscopic thermal stabilization for distal radioulnar joint instability: 3 to 19 years follow-up

Cited by 6 publications

References 33 publications

Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study

Radius distraction during volar plating of distal radius fractures may improve distal radioulnar joint stability at minimum 3-year follow-up: a retrospective case series study

Experience with Diagnosis and Management of Distal Radioulnar Joint Instability

Clinical Outcomes of Arthroscopic Ligament-Sparing Dorsal Capsulodesis for Partial Scapholunate Ligament Tear

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