Abstract
Background
Distal radioulnar joint (DRUJ) stability during unrestricted forearm rotation relies on several factors, including the integrity of the triangular fibrocartilage complex (TFCC), the interosseous membrane, the bony configuration of the sigmoid notch, DRUJ capsule, and the extensor carpi ulnaris tendon with its subsheath. There are currently numerous reported surgical approaches for TFCC repair, however, postoperative DRUJ instability rates are still reported to be around 8 to 12%. As the integrity and strength of the TFCC is crucial for DRUJ stability, it is thus critical to identify if intraoperative dorsal capsular imbrication can further enhance DRUJ stability for improved functional outcomes.
Methods
A retrospective study was performed on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were assessed to be suitable and recruited for our study. 135 patients underwent our arthroscopic “cross-form TFCC repair” without dorsal capsular imbrication (CR) and 90 patients underwent our arthroscopic “cross-form TFCC repair” with dorsal capsular imbrication for augmentation of DRUJ stability (DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PRO) were evaluated, and all patients were follow-up for a minimum of 3 years postoperatively.
Results
Both groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PRO between the preoperative and postoperative periods (p < 0.05). Significantly lower recurrent DRUJ instability was noted in the DCI group (3.7% vs 1.1%, p < 0.05). Re-operative rates were also noted to be lower in the DCI group (2.2% vs 1.1%). However, the DCI group was found to have inferior ROM as compared to the CR group.
Conclusion
Dorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability and reoperation rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.