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Arthroscopic Treatment of Ulnar Extrinsic Ligament Injuries
Russell D. Rosenberg; Norah M. Harvey, MD; Sidney M. Jacoby, MD; Randall W. Culp, MD
The Philadelphia Hand Center, Thomas Jefferson University, Philadelphia, PA

Background and Aim: The ulnotriquetral and ulnolunate ligaments are functionally related yet anatomically distinct structures.  Together referred to as the ulnar extrinsic ligaments, these structures provide both stability to the wrist while also allowing for dynamic motion.  The ulnar extrinsics attach proximally to the palmar radioulnar ligament, and distally to the proximal palmar lunate and triquetrum.  As a result of their biomechanical configuration, they are susceptible to longitudinal tears resulting from axial loading of the hand, radial extension of the wrist, and supination of the forearm1.  The purpose of this study was to examine the use of arthroscopic treatment of the ulnar extrinsic ligaments after identifiable injury.

Methods: A review of 50 patients with ulnar extrinsic ligament injury who underwent arthroscopic repair was conducted.  Arthroscopic evaluation was used to first determine the integrity of the ulnar extrinsics; those with ligamentous laxity were treated with thermal capsulorrhaphy while those with ligament tears were treated with outside-to-inside repair using a Meniscus Mender.  Pre and post operative changes in range of motion and grip strength were evaluated as well as complication rates.

Results: 30 patients (60%) received ulnar extrinsic capsulorrhaphy, while the remaining 20 patients (40%) were treated with additional suture repair as described above.  Average grip strength improved 25% after surgery, with clinically insignificant changes to wrist flexion, extension, pronation, and supination.   7 patients (14%) sustained complications that required surgical intervention including infection (2), lunotriquetral ligament tear (3), extensor carpi ulnaris subluxation (1), and supination deformity and pain (2).

Conclusions: Considering the dramatic increase in grip strength without compromising ROM, as well as the minimal complication rate seen in our study, arthroscopic treatment appears to be a viable option for the treatment of ulnar extrinsic ligament injuries.

1Tay SC, Berger RA, Parker WL. Longitudinal Split Tears of the Ulnotriquetral Ligament. Hand Clin. 2010; 26(4):495-501

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