Treatment of isolated injuries of the lunotriquetral ligament

Abstract

We studied 57 patients with isolated lunotriquetral injuries treated by arthrodesis, direct ligament repair, or ligament reconstruction. The outcomes were compared by using written questionnaires, the Disabilities of the Arm, Shoulder and Hand (DASH) score, range of movement, strength, morbidity and rates of reoperation. Isolated lunotriquetral injury was confirmed by arthroscopy or arthrotomy. The mean age of the patients was 30.7 years (15.4 to 53.7) and the injuries were subacute or chronic in 98.2%. Eight patients underwent lunotriquetral reconstruction using a distally-based strip of the tendon of extensor carpi ulnaris, 27 had lunotriquetral repair and 22 had lunotriquetral arthrodesis. The mean follow-up was 9.5 years (2 to 22). The probability of remaining free from complications at five years was 68.6% for reconstruction, 13.5% for repair, and less than 1% for arthrodesis. Of the lunotriquetral arthrodeses, 40.9% developed nonunion and 22.7% developed ulnocarpal impaction. The probability of not requiring further surgery at five years was 68.6% for reconstruction, 23.3% for repair and 21.8% for arthrodesis. The DASH scores for each group were not significantly different. Objective improvements in strength and movement, subjective indicators of pain relief and satisfaction were significantly higher in the lunotriquetral repair and reconstruction groups than in those undergoing arthrodesis.

Ligamentous Injuries of the Wrist

“…103 Shin et al demonstrated that 80% of patients who had open repair were satisfied with the outcome and the rate of complication was 40%. 105 LTL reconstruction is a procedure indicated more often than open repair. Recently, two procedures have been mainly applied: extrinsic tenodesis and dorsal capsular reinforcement.…”

“…106 Shin et al found that although complications and reoperation rates Figure 18 The technique of reconstruction of the lunotriquetral ligament with a distally based strip of the tendon of extensor carpi ulnaris. From Shin et al, 105 with permission. Figure 19 Illustration of the reticular flap technique.…”

Lunotriquetral injuries

“…The aim of repair is to restore carpal kinematics. Although Ritt et al 13 showed in cadavers that ligament repair does not reproduce normal carpal kinematics, clinical results 2,28 suggest that the procedure effectively relieves symptoms. Primary ligament repair is less efficacious when performed after the acute inflammatory response or when performed in patients demanding high use.…”

“…Primary ligament repair is less efficacious when performed after the acute inflammatory response or when performed in patients demanding high use. 28 In patients with chronic injuries, ligament reconstruction should be weighed against lunotriquetral fusion. Reconstruction is performed by using the radial half of the extensor carpi ulnaris tendon, leaving its distal attachment intact.…”

“…Attenuation or hemorrhage of interosseous ligament as viewed from the radiocarpal joint No incongruency of carpal alignment as viewed from the midcarpal space Attenuation or hemorrhage of interosseous ligament as viewed from the radiocarpal joint Step-off of carpal alignment as viewed from the midcarpal space, probe is unable to pass into the gap Incongruency or step-off of carpal alignment as seen from both radiocarpal and midcarpal spaces, probe may be passed between carpal bones Incongruency or step-off of carpal alignment as seen from both radiocarpal and midcarpal spaces, gross instability with manipulation, 2.7-mm arthroscope may be passed through the gap between the bones Additionally, it is supported by only one published outcome study at the present time. 28 Our own experience has been that arthrodesis is a reliable option if the lunotriquetral joint is adequately decorticated, autogenous bone graft is used, the correct anatomic relationships of the various carpal bones are maintained, and ulnar abutment, if present, is properly addressed. Lunotriquetral fusion has been used widely with results varying from fair to excellent.…”