Tenodesis of the extensor carpi ulnaris for chronic, post-traumatic lunotriquetral instability

Abstract

We describe a technique of soft-tissue reconstruction which is effective for the treatment of chronic lunotriquetral instability. Part of extensor carpi ulnaris is harvested with its distal attachment preserved. It is passed through two drill holes in the triquetrum and sutured to itself. This stabilises the ulnar side of the wrist. We have reviewed 46 patients who underwent this procedure for post-traumatic lunotriquetral instability with clinical signs suggestive of ulnar-sided carpal instability. Standard radiographs were normal. All patients had pre-operative arthroscopy of the wrist at which dynamic lunotriquetral instability was demonstrated. A clinical rating system for the wrist by the Mayo clinic was used to measure the outcome. In 19 patients the result was excellent, in ten good, in 11 satisfactory and in six poor. On questioning, 40 (87%) patients said that surgery had substantially improved the condition and that they would recommend the operation. However, six (13%) were unhappy with the outcome and would not undergo the procedure again for a similar problem. There were six complications, five of which related to pisotriquetral problems. The mean follow-up was 39.1 months (6 to 100). We believe that tenodesis of extensor carpi ulnaris is a very satisfactory procedure for isolated, chronic post-traumatic lunotriquetral instability in selected patients. In those with associated pathology, the symptoms were improved, but the results were less predictable.

Dorsal Radiocarpal Ligament Capsulodesis for Chronic Dynamic Lunotriquetral Instability

“…1 In addition, because LT arthrodesis has variable outcomes and high complication rates, 10,26 authors have recently explored the soft tissue approach for treating LT instability by arthroscopic or open surgery. [11][12][13][14]17,27 Moskal et al 27 treated 20 patients with partial LT ligament tear using arthroscopic capsulodesis of the LT joint, with good results. Reagan et al 11 introduced ligament reconstruction using a distally based strip of the extensor carpi ulnaris tendon, in which simultaneous reconstruction of both dorsal and volar LT ligaments was possible.…”

“…The surgical treatment options for chronic LT instability include LT fusion, 7-10 ligament repair, 2,11 and reconstruction. [11][12][13][14] Shin et al 2 retrospectively reviewed 57 patients with chronic isolated LT injuries who had undergone 3 different procedures. Compared with ligament repair and reconstruction, LT fusion provided less satisfactory results and had a higher reoperation rate.…”

Diagnosis and Treatment of Chronic Lunotriquetral Ligament Injuries

“…2,5,10,16,20 Shahane and colleagues 20 examined 46 patients with chronic posttraumatic LT instability who underwent LT tenodesis with the ECU tendon. At a mean follow-up of 19 months, 19 patients had excellent and 10 had good results, but six patients had poor results and reported they would not undergo the procedure again if given the opportunity.…”

“…A technique using a distally based ECU graft was introduced by Reagan and colleagues 5 and later modified by Shin and Bishop 16 and Shahane and colleagues. 20 Briefly, a dorsal approach to the wrist is used from the third through fifth extensor compartments, performing a ligament-sparing capsulotomy, and exposing the LT ligament (as described previously). After LT inspection, the lunate and triquetrum are reduced anatomically and stabilized with extra-articular K-wires.…”

Chronic Carpal Instability

“…A third alternative has been proposed by the colleagues at the Wrightington Hospital in UK. It consists of creating a vertical tether to the triquetrum, with a strip of ECU tendon passed through a bone tunnel on the dorsal aspect of the triquetrum, and triangular fi brocartilage [ 48 ] (Fig. 10.6 ).…”