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Patient Rated Outcomes of Anatomic Radioulnar Ligament Reconstruction
Mark Henry, MD; Hand and Wrist Center of Houston
Hand and Wrist Center of Houston, Houston, TX, USA

INTRODUCTION

Deficiency of the radioulnar ligament (RUL) may lead patients to report pain and functional instability at the distal radioulnar joint (DRUJ). Previously described free tendon graft reconstructions have correctly reproduced the ulnar foveal origin but not the sigmoid notch insertions. We report the outcomes of a reconstruction that reproduces the true anatomic attachments of the original RUL.

METHODS

Twenty five patients (19 males, 6 females) were included in the study based on: chronic symptoms of DRUJ instability, demonstrable instability on examination, MRI evidence of RUL deficiency, and arthroscopic findings of foveal disruption of the RUL. Exclusion criteria were: distal radius malunion, congenital malformation of the sigmoid notch, and DRUJ arthritis. Mean age was 35 years old with a mean interval from injury to surgery of 5 months. Radioulnar ligament reconstruction was performed with a free tendon graft from the ulnar fovea to two separate coronal plane drill tunnels entering at the anatomic points of original ligament attachment to the articular margins of the sigmoid notch. Patients were examined post-operatively at 2 weeks, 4 weeks, 6 weeks, 12 weeks, and 6 months. Final evaluation averaged 51 (+/- 14) months following surgery. Measures obtained before and after treatment included: wrist range of motion, forearm range of motion, grip strength, examination findings of DRUJ instability, and Disabilities of Arm, Shoulder, and Hand (DASH) scores. Pre-operative and post-operative measures were compared using the paired Student’s t-test, accepting a p-value of 0.05 as statistically significant.

RESULTS

All patients healed the reconstruction without major complications and demonstrated DRUJ stability at the 6 month examination. Mean ranges of motion, in degrees, pre / post-operative were: wrist flexion 53 (+/- 13) / 61 (+/- 10), wrist extension 53 (+/- 13) / 62 (+/- 15), supination 65 (+/- 12) / 74 (+/- 7), and pronation 66 (+/- 11) / 71 (+/- 8). Grip strengths expressed as % contralateral pre / post-operative were: 57 (+/- 23) / 79 (+/- 25). The differences in these measures were not found to be statistically significant. The mean pre / post-operative DASH scores were: 62 (+/- 16 ) / 7 (+/- 3). This difference was found to be statistically significant.

CONCLUSION

Free tendon graft reconstruction can accurately replicate all three major anatomic RUL attachments without losing motion or grip strength. Patients remain stable to ligament stress testing and report lower DASH scores.


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