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Recibido el 30 de julio de 2014; aceptado el 5 de mayo de 2015 Disponible en Internet el 23 de noviembre de 2015 PALABRAS CLAVE Hallux rigidus; Coughlin y Shurnas; Clasificación; ReproducibilidadResumen Existen diversas clasificaciones descritas en la literatura para los hallux rigidus. La clasificación de Coughlin y Shurnas es probablemente la más utilizada, empleándose tanto para la estadificación como para la decisión terapéutica. El objetivo de este estudio es evaluar su reproducibilidad a partir de su concordancia inter e intraobservador. Se obtuvo una muestra de 13 pacientes con diagnóstico de hallux rigidus (7 de ellos bilateral), sumando 20 casos. Se citó individualmente a todos los pacientes en consultas externas en 2 visitas separadas por 30 días. En cada visita fueron clasificados por los 3 observadores para los diferentes parámetros de la clasificación de Coughlin y Shurnas: arco de movilidad, radiología, clínica y en un grado final. Se realizó un estudio de correlación inter e intraobservador que resultó en una correlación buena o muy buena para los parámetros de arco de movilidad, radiología y grado final, encontrándose una pobre correlación para la clínica. En conclusión, la clasificación de Coughlin y Shurnas es reproducible para valorar la estadificación de los hallux rigidus.Abstract There are several classifications described in the literature for hallux rigidus. Coughlin and Shurnas classification system is probably the most widely used in this field, for both the staging and therapeutic decision. The objective of the present study was assessing the reproducibility of this classification system, based on the concordance between inter-and intraobserver. A sample of 20 cases was obtained based on 13 patients diagnosed with hallux rigidus (7 of them were bilateral). All patients were scheduled individually in outpatient services on 2 visits separated by 30 days. During each visit they were classified by 3 observers for the different parameters of Coughlin and Shurnas classification: range of motion, radiology, clinics, and finally in a final * Autor para correspondencia. Correo electrónico: xlizano@gmail.com (X. Lizano-Díez).http://dx.

Introduction There has been an increase in the diagnosis of injuries to the intrinsic ligaments of the wrist due to the more widespread use of arthroscopy in the treatment of patients with musculoskeletal wrist pain, and arthroscopy is particularly very helpful to determine the etiology of these lesions at the ulnar level. The treatment of lunotriquetral ligament injuries encompasses different techniques with results that are little reproducible. Ligament reconstruction through tendon grafting has shown favorable results, but it involves extensive open approaches that lead to a slower recovery a lower range of joint motion due to the excess of scar tissue. The objective of the present study is to describe the performance, in a cadaver, of a minimally-invasive lunotriquetral and secondary-stabilizer ligamentoplasty and its application in a representative clinical case. Material and Methods A preliminary study of six specimens in which a lunotriquetral and secondary-stabilizer ligamentoplasty was performed consecutively through a free tendon graft with arthroscopic assistance. We proceeded to recreate the complete ligament injury, and to perform an assessment of lunotriquetral instability according to the Geissler classification and an arthroscopic ballottement test. We describe the surgical technique, ligament stability after the ligamentoplasty, and the subsequent anatomical dissection, assessing the anatomical structures susceptible to iatrogenic injury. We also describe the application of the technique in one case, comparing the clinical parameters before and after the procedure: range of motion of the joint, strength, pain and the shortened version of the Disabilities of the Arm, Hand, and Shoulder (QuickDASH) questionnaire. Results The ligamentoplasties performed showed recovery of the stability of the lunotriquetral interval assessed according to the Geissler classification and the arthroscopic ballottement test. In the dissection of the specimens, no iatrogenic lesions were found in the tendons or the surfaces of the mediocarpal and radiocarpal joints. The average distances between the nearest bone tunnels and nerves were of 7.3 mm for the sensory branch of the ulnar nerve, of 3.6 mm for the posterior interosseous nerve, and of 4.5 mm for the ulnar neurovascular bundle. No fractures were observed in the tunnelled bones. In the clinical case herein presented, six months after the intervention, there was an improvement in strength and preoperative pain, with a slight decrease in the joint range of motion (15% compared to the contralateral joint). Conclusions The lunotriquetral ligamentoplasty herein described could contribute to the biomechanical restoration of the carpus and be an option for recosntruction in selected cases. Its performance through minimally-invasive techniques, and the use of a free tendon graft together with specific rehabilitation should be considered to optimize the outcomes.