Anatomic Reconstruction of the Radioulnar Ligament

Abstract

Introduction Twenty-five patients (19 males and six females) were included in the study based on: chronic symptoms of distal radioulnar joint instability, demonstrable instability on examination, MRI evidence of radioulnar ligament deficiency, and arthroscopic findings of foveal disruption of the radioulnar ligament. Materials and Methods Exclusion criteria were: distal radius malunion, congenital malformation of the sigmoid notch, DRUJ arthritis, and less than 24 months minimum follow-up. Mean age was 35 years old with a mean interval from injury to surgery of 5 months. Surgery began with arthroscopic confirmation of the chronic foveal detachment followed by open reconstruction of the radioulnar ligament using the palmaris longus tendon. The specific method employed three drill tunnels corresponding to the true anatomic points of attachment of the radioulnar ligament. Patients were examined post-operatively at 2 weeks, 4 weeks, 6 weeks, 12 weeks, and 6 months. Results and Discussion Final evaluation averaged 51 (±14) months following surgery. Measures obtained before and after treatment included: wrist range of motion, forearm range of motion, grip strength, examination findings of distal radioulnar joint instability, and Disabilities of Arm, Shoulder, and Hand (DASH) scores. Pre-operative and postoperative measures were compared using the paired Student's t test, accepting a p value of 0.05 as statistically significant. All patients healed the reconstruction without major complications and demonstrated distal radioulnar joint stability at the 6-week examination. Mean ranges of motion, in degrees, pre-/post-operative were: wrist flexion 53 (±13)/61 (±10), wrist extension 53 (±13)/62 (±15), supination 65 (±12)/74 (±7), and pronation 66 (±11)/71 (±8). Grip strengths expressed as % contralateral pre-/post-operative were: 57 (±23)/79 (±25). The differences in these measures were not found to be statistically significant. The mean pre-/post-operative DASH scores were: 62 (±16)/7 (±3). This difference was found to be statistically significant. Conclusion Reconstruction of the RUL with a free palmaris longus tendon graft using the truly anatomic points of original RUL attachment at both the ulna and radius restored DRUJ stability and improved DASH scores without limiting forearm or wrist motion.