Dorsal Capsuloplasty for Dorsal Instability of the Distal Ulna

Abstract

Background Dorsal instability of the distal ulna can lead to chronic wrist pain and loss of function. Structural changes to the dorsal radioulnar ligaments (DRUL) of the triangular fibrocartilage complex (TFCC) and the dorsal capsule around the ulnar head with or without foveal detachment can lead to volar subluxation of the distal radius e.g., dorsal instability of the distal ulna. Purpose Is to evaluate the post-operative results of reinstituting distal radioulnar joint (DRUJ) stability through reefing of the dorsal capsule and dorsal radioulnar ligaments, with and without a foveal reattachment of the TFCC. Methods A total of 37 patients were included in this retrospective study. Diagnosis and treatment was based strictly on dry wrist arthroscopy. In 17 patients isolated reefing of the DRUL and their collateral tissue extension was performed. In 20 patients an additional foveal reinsertion was performed. Postoperative results were evaluated with the DASH questionnaire, VAS scores, grip strength and range of motion. These findings were extrapolated in the Mayo wrist score. The two subgroups were compared. Results Mayo wrist scores of the whole population had a mean of 73. There was no difference between the group that was treated with reefing of the DRUL only and the group that was treated with a combined foveal reinsertion. Conclusion This relatively simple 'dorsal reefing' procedure, with foveal reinsertion when indicated, is a reliable method to restore volar-dorsal DRUJ stability with a significant decrease in pain sensation, good DASH scores and restoration of functional grip strength and ROM. Type of Study/Level of Evidence Therapeutic, Level IV.

Chronic Posttraumatic Instability of the Distal Radioulnar Joint: Foveal Reattachment of the Triangular Fibrocartilage Complex With Dorsal Capsuloplasty and Extensor Retinaculum Imbrications

“…Gofton et al 28 compared the dorsal capsular imbrication and 3 other types of surgical reconstruction for the treatment of DRUJ instability, concluding that the Adams reconstruction, 23 the modified Fulkerson-Watson reconstruction, 29 and the Bowers reconstructions 30 significantly improved the stability, but stated that the capsular imbrication was the repair technique that most resembles the DRUJ kinematics. Manz et al, 16 Kouwenhoven et al, 17 Ahrens et al, 18 Unglaub et al 19 and Spies et al, 20 published their case series of DRUJ posttraumatic instability that was treated by a dorsal joint capsule imbrication with excellent results. This technique has become our main surgical option for the treatment of DRUJ chronic posttraumatic instability, because it is relatively simple, easily reproducible, without the need for grafting and large bone perforations, as well as multiple incisions.…”

“…11 Some articles state that in addition to the TFCC, the joint capsule also has a critical stabilizing function; 12-15 and therefore, many authors are considering the capsular imbrication as a surgical option in cases of the DRUJ posttraumatic instability. 16-20…”

“…11 Some articles state that in addition to the TFCC, the joint capsule also has a critical stabilizing function; [12][13][14][15] and therefore, many authors are considering the capsular imbrication as a surgical option in cases of the DRUJ posttraumatic instability. [16][17][18][19][20] The extensor retinaculum imbrication can also be used to restore the DRUJ stability. This technique consists of making an ulnar-based retinacular flap that crosses the fifth extensor compartment to create extra-articular support similar to the anatomical course of the dorsal radioulnar ligament.…”

Effect of Dorsal Capsular Imbrication on Intraoperative DRUJ Instability following Arthroscopic TFCC Repair Surgery

“…In our prior comparative research [20], the mean ± standard deviation of wrist range of motion (ROM), with respect to pronation and supination, was found to be 161 ± 13.6º, and 156 ± 12.6º in the "dorsal capsular imbrication" group and the "TFCC repair + dorsal capsular imbrication" group, respectively.…”

“…The dorsal capsular imbrication (DCI) technique has been proposed and reported to yield positive clinical results in chronic DRUJ dislocation cases [17][18][19][20][21][22][23][24][25]. However, the use of DCI as a reinforcement procedure in TFCC repair operations for chronic DRUJ instability has not been extensively studied.…”