Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry

Abstract

Purpose Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). Methods In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. Results The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). Conclusion In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.

Normal Values of Distal Radioulnar Joint Kinematics during a Dynamic Press Test

“…Press test examination and AutoRSA analysis in patients with confirmed TFCC injuries have not yet been evaluated, but is likely applicable, and previous cadaver studies have shown promising results concerning detection of differences in DRUJ translations using RSA. 9,23 Evaluation of kinematic differences between uninjured and injured forearms remains to be examined in vivo.…”

Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies

“…(2) the sample; (3) the condition of the specimen; (4) the study protocol; (5) the expertise level of the dissecting researchers; (6) interobserver reliability; (7) results; (8) statistic tools; (9) the consistency of findings; (10) photographs of the observations; (11) results in relation to current evidence; (12) clinical relevance; and (13) study limitations. Each item can be scored as "yes" or "no" (1 or 0 points), with an exact description of when to score "yes."…”

“…All studies created a Palmer type 1B TFCC tear. A total of 72 cadaver arms (range, [12][13][14][15][16][17][18][19][20] were included in this review. Four of the included studies used matched-pairs of fresh-frozen cadaveric forearms.…”

“…12,13 For example, testing DRUJ stability in patients is subjective and has low interrater reliability. 12,14 Also, various computed tomographic (CT) methods for evaluating DRUJ instability lack accuracy and still underestimate and overestimate the extent of subluxation. [15][16][17][18] Until now, no study has summarized the outcomes of the biomechanical cadaver studies.…”

“…In cadavers, translation movements between the ulna and the radius can be measured objectively and quantified, giving a more accurate indication of possible DRUJ translation than imaging techniques or physical examination. 12 , 13 For example, testing DRUJ stability in patients is subjective and has low interrater reliability. 12 , 14 Also, various computed tomographic (CT) methods for evaluating DRUJ instability lack accuracy and still underestimate and overestimate the extent of subluxation.…”