Outcomes of ulnotriquetral split tear repair: a report of 96 patients

Abstract

Ninety-six wrists (56 right and 40 left) in 96 patients (36 males and 60 females, mean age 38, range 15–77 years) underwent repair of ulnotriquetral ligament split tears between 2007 and 2016. Mayo wrist scores, visual analogue scale pain scores, and objective measures including grip strength and range of motion were obtained. Patients were assessed after a mean follow-up of 21 months (range 6–112 months). Ulnotriquetral split tear repair resulted in substantial improvements in pain and function. The mean Mayo wrist score improved from 57 preoperatively to 81 postoperatively, with 84% of patients achieving a good or excellent outcome. Pain scores decreased from 5.8 to 1.2. Grip improved from 25 kg to 29 kg. There was no significant change in range of motion of the wrist. Complications were noted in eight patients, with three experiencing continued pain, four with dysaesthesia of the dorsal sensory ulnar nerve, and one superficial infection. Arthroscopic ulnotriquetral split tear repair significantly reduced pain and improved Mayo wrist scores. Level of evidence: IV

Surgeon level of expertise reported in Journal of Hand Surgery (American Volume) and (European Volume) publications

“…The current review demonstrates an increase in number and percentage of reported LOE in the J Hand Surg Eur publications. Among these publications with LOE declaration in the European journal, many are American authors (Boe et al., 2018; Clark et al., 2019a, 2019b, Kazmers et al., 2019; Lovy et al., 2019; Trehan et al., 2019). It is clear that it is not American authors who have resistance or difficulty in declaration of LOE.…”

Ulnar Wrist Pain in a Tennis Player: Case Review and Discussion

“…The authors reported a minor improvement in mean grip strength (33 kg postoperatively compared with 31 kg preoperatively), no difference in range of motion, and a mean Disabilities of the Arm, Shoulder and Hand (DASH) score of 7.5 points at 28 months postoperatively 6 . More recently, Clark et al retrospectively examined 96 wrists that underwent UT ligament repair over a 10-year period 17 . In this series, 84% (81) of 96 patients had a good or excellent outcome, with significant postoperative improvements noted in mean visual analog scale (VAS) scores for pain (5.8 preoperatively compared with 1.2 postoperatively; p < 0.0001), grip strength (25 kg preoperatively compared with 29 kg postoperatively; p = 0.006), and Mayo Wrist Scores (57 points preoperatively compared with 81 points postoperatively; p < 0.0001).…”

“…There has been limited literature detailing the outcomes of surgically treated UT ligament split tears 6,17 ) that resolved with a short course of oral antibiotics. The reoperation rate was 5% (5 of 96) and was indicated for a recurrent tear with continued pain (2 patients), ulnar impaction requiring an ulnar shortening osteotomy (1 patient), scar revision (1 patient), and removal of a prominent suture (1 patient).…”

“…Diagnosis has been guided by an improved understanding of ulnar wrist anatomy, novel examination maneuvers, and increased experience with arthroscopic techniques 6 . Acute, traumatic injuries to the UT ligament during wrist hyperextension and supination represent 48% to 64% of tears 6,17 , but repetitive use injuries, especially in racquet, bat, or stick-handling sports, are also seen 6,18 . The mean age of a patient with a UT split tear is 30 years, about half of UT split tears occur in men, and one-third of tears occur in athletes 6 .…”

Arthroscopic Anatomy of the TFCC with Relevance to Function and Pathology

“…The diagnosis of longitudinal split tears of the UTL described by Berger in 2007 can only be made with an arthroscope. 22,23 Avulsion of the ulnocarpal ligaments from the lunate and/or triquetrum (►Fig. 5D).…”