Artikel
Ligamentoplasty of the palmar ulnoradial ligament at the distal radioulnar joint by bone ligament transplant from the extensor retinaculum – technique and preliminary results
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Autoren
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Heinrich-Geert Tünnerhoff
- Praxis und Belegabteilung f Handchirurgie, Marbach, Germany
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: For painful instability of the distal radioulnar joint (DRUJ) in some cases a ligament reconstruction is necessary. The ulnoradial liagments may be replaced by a free tendon graft either by reconstructing the whole complex or - more simply - by replacing only the ulnar part ascending from the fovea fixing this to the remnants of the ligaments at the radius. In the many cases, in which due to the secondary stabilizers only the palmar translation of the radius in relation to the ulna is clinically evident and needs to be addressed a reconstruction of only the palmar ulnoradial ligament is sufficient. However all these reconstructions using tendons as a graft are prone to secondary loosening.
A new technique of a bone ligament transplant to overcome these problems is presented
Methods: A bone ligament transplant taken from the extensor retinaculum is used. The bone taken as graft by chisels between the 2nd an 3rd compartment is cut to shape by a fine rongeur and pressed by a template block to be a cylinder which fits into a 6,0 mm drill whole made in a oblique direction from the ulnar neck towards the fovea. The exit at the fovea is only drilled to 4 mm, so the exit of this channel is narrower than the entry and the graft is firmly pressed into the bone. The ligamentous part, which includes fibres from the extensor retinaculum towards the 6th and the 1st compartment is grasped by a multiple looped thread and pulled out of the end of the channel in the fovea and is interwoven to the remnants of the palmar ulnoradial ligament under adequate tension. The arm is immobilized for 6 weeks.
Results and Conclusions: From 2016 5 patients (4 female, 1 male, average age 36 y), all cases of recurrent instability after previous surgery, have been operated by this technique with a minimum of 6 months follow up. All of them regained free motion and stability of their DRUJ. Standard - X rays of the wrist taken after 6 weeks showed good healing of the transplanted bone in all cases. No complications referred to the technique of taking and inserting the graft occurred. In one case an additional ulnar shortening was done at the same time. 4 patients are free of pain, one has a stable joint but pain due to arthritic changes at the radiolunate joint.
Replacing the ulnar part of the palmar ulnoradial ligament by a free bone ligament graft from the extensor retinaculum is an option to stabilize the DRUJ in the numerous cases of unilateral palmar instability (palmar subluxation of the radius against the ulnar head).
