Comparison of 2 Forearm Reconstructions for Longitudinal Radioulnar Dissociation: A Cadaver Study

Abstract

Treatment of longitudinal radioulnar dissociation may benefit from radial head replacement and interosseous ligament reconstruction using a patellar tendon graft.

Suture-Button Reconstruction of the Interosseous Membrane

“…Remaining evidence is in the form of biomechanical studies that adhere to no universal protocol and are therefore difficult to compare. Further confusing an appraisal of various reconstruction techniques is the fact that, rather than directly measuring inter-articular pressures, previous investigators have gathered different proxy data, for example, radioulnar translation, 4,[8][9][10][11]13,14 forces within the forearm bones, 4,5,[9][10][11]15 and/or forces within the IOM 13,14 to make conclusions about pressures at the wrist or elbow. The ultimate measure of any forearm reconstruction is the effect of the technique on intra-articular pressures, particularly at the wrist, as painful ulnocarpal impaction is most often the impetus for surgery.…”

“…of suture-button reconstruction 8,9 and several biomechanical studies of graft-based techniques. 4,5,[10][11][12][13][14][15][16] Suture-button reconstruction is of particular interest because it obviates donor site morbidity and requires minimal dissection, making it relatively easy to perform. How suture button-based reconstruction compares to other motion-sparing reconstructive techniques is unknown.…”

Essex-Lopresti injuries: an update

“…Even if the RH is fixed or replaced, a longitudinal radioulnar displacement can occur after axial loading. 25,26 In any case, the excessive forces through the radiocapitellar joint predispose for early implant instability, arthritis and pain. 17,19,27 Additionally, the low healing potential of the CB preclude the possibility that the CB will heal on its own.…”

“…The use of bone-patellar-bone (BPB) tendon autograft has also been described. 26,31–33 Stabile et al 31 compared the structural properties of BPB graft with Achilles tendon and FCR grafts and found that all three structures were inferior to the native IOM, although the BPB tendon was slightly stiffer than the other two. Another biomechanical study comparing three tendon autografts (palmaris longus, FCR and BPB) yielded similar results.…”

“…32 In another study, it was suggested that a RH arthroplasty in LRUD should be combined with a reconstruction procedure, as it can significantly reduce distal ulnar force. 26,33 In fact, force transmission through the distal ulna was measured after CB reconstruction with and without a RH prosthesis; although the RH implant was the most important component in restoring longitudinal stability, the addition of a reconstruction procedure decreased the distal ulnar forces to normal levels. 26…”