Correction of chronic lunotriquetral instability using extensor retinacular split : A retrospective study of 26 patients


Published online: Aug 27 2007

Ilkka Antti-Poika, Jukka Hyrkäs, Liisa M Virkki, Daisuke Ogino, Yrjö T Konttinen

From the Orto-Lääkärit Medical Center, Helsinki, Finland, Helsinki University Central Hospital, Helsinki, Finland, the ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland, and the COXA Hospital for the Joint Replacement, Tampere, Finland

Abstract

Arthroscopy offers a welcome and reliable supplement to the current tool set for the diagnosis of lunotriquetral (LT) instability. This study reports the findings of LT-lesions during arthroscopy and the clinical results obtained after using dorsal stabilisation in its surgical management using extensor retinacular split. LT-instability of grade I-III was diagnosed in 26 patients. Imaging results were normal, Reagan's ballottement and Watson tests were positive in 47% and 79%, respectively. After arthroscopic diagnosis, the procedure was immediately continued with an open repair utilising an 8-10 mm wide and radial-based extensor retinacular split for dorsal capsular reinforcement. At 39 months (range : 14 to 84) follow-up, 64% had no or only occasional mild pain and 36% had pain with overuse or lifting. Overall scoring encompassing pain, patient satisfaction, range of motion and grip strength, was excellent in 24% and good in 64%. Only three patients had fair results, one after a further injury leading to distal radio-ulnar joint (DRUJ) instability, and two with concurrent DRUJ-stabilisation. One further patient required a secondary procedure. Arthroscopy seems to allow accurate diagnosis of LT-instability and can be continued in the same session using a straightforward reconstruction procedure providing satisfactory results.