Ligament reconstruction for distal radioulnar joint instability with the biomechanical analysis: A case report

Abstract

Rationale: The aim of the study is to evaluate the clinical effects and feasibility on chronic distal radioulnar unstable joint (DRUJ) under wrist arthroscope triangular fibrocartilage complex (TFCC) repair and reconstruction. The biomechanical characteristics of the recovery process after treatment were analyzed using finite element modeling. Patient concerns: A patient with chronic DRUJ instability was treated with reconstruction of the distal radioulnar ligament using the Adams Berger method. Piano sign and forearm rotation tests were used to evaluate the function of the DRUJ. Grip power, range of motion, and visual analog scale scores were recorded at the last follow-up. Joint function was evaluated by the disability of the arm, shoulder, and hand score. A geometric model for the surgical repair of TFCC damage, meshing in finite element simulation, and stress distribution of the repaired ligament during forearm rotation were analyzed by finite element simulation. Diagnoses: The diagnosis was confirmed as chronic DRUJ instability. Interventions and outcomes: The patient had no postoperative complications and was followed-up for 6 months. Stability was achieved in all patients. The results of the stress and forearm rotation tests are negative. At the last follow-up, the grip power, disability of the arm, shoulder, and hand score, visual analog scale score, and range of motion of the wrist were significantly improved compared with the preoperative values (P < .05). Lessons: TFCC repair and reconstruction under wrist arthroscopy can effectively treat chronic DRUJ and improve wrist function. Our study established a three-dimensional finite element model of the entire DRUJ, which provided a digital visual platform for simulating the biomechanical features of the TFCC, DRUJ, and other structures in different states. This study demonstrated that the rotation angle of the wrist joint should be confined within 75° for a short period after surgery to avoid tearing the tendon as a result of excessive force. It also provides an intuitive simulation tool for the design of TFCC repair and the evaluation of curative effects.