Arthroscopic Treatment of Intrinsic Ligament Injuries of the Wrist

Abstract

The management of ligament injuries of the wrist has always constituted a challenge for hand surgeons. The advent of wrist arthroscopy has facilitated the diagnosis, improved the understanding of the etiopathogenesis, and helped in the development of new therapies for these lesions with promising early to midterm results. Apart from the rare lunotriquetral ligament injuries and the complex midcarpal instability, triangular fibrocartilage complex (TFCC) injuries and scapholunate ligament (SLL) tears are the most frequently seen injuries in clinical practice. However, recent advances in the understanding of the anatomy and function of the scapholunate ligament have led to the evolution of a novel concept – the so-called scapholunate ligament complex. Triangular Fibrocartilage Complex (TFCC) Injuries Introduction According to the classification of Palmer (1989), lesions of the triangular fibrocartilage (TFCC) are divided into two basic categories, traumatic lesions (type 1) and degenerative (type 2), which are themselves divided into different subtypes depending on the location of the lesion and the presence or absence of cartilage defects. Traumatic lesions or type 1 injuries are divided into four types, of which type 1B corresponds to peripheral lesions located at the ulnar insertion of the TFCC. These lesions are the most common and best known. Recent anatomical and histological studies have shown that the ulnar part of the triangular fibrocartilage is actually located in separate complex threedimensional components, viz., the proximal part, the distal hammock/sling-like structure, and the ulnar collateral ligament (UCL) (Nakamura et al. 1996). The ulnar collateral ligament (UCL) can be thought of as being associated with the distal hammock because it shares the same function of suspension and transmission of forces on the ulnar aspect of the wrist (Nakamura et al. 1996). Both of these structures can be considered as the distal component of the ligament (TFCC) in comparison to the proximal portion of the TFCC (Fig. 1). The proximal portion of the triangular fibrocartilage (TFCC) is attached to the fovea of the ulnar head and inserts on both sides of the sigmoid notch of the distal radius by the palmar and dorsal radioulnar ligaments that stabilize the distal radioulnar joint (Nakamura andMakita 2000). Different components of these ligaments can be injured in isolation or in combination. Unlike lesions of the proximal portion of the TFCC that may cause instability of the distal radioulnar joint, the stability of the distal radioulnar joint is preserved in isolated lesions of the distal component, conventionally known as type 1B lesions according to Palmer. Many arthroscopic techniques have been proposed to suture the ligament damage to the dorsal capsule (Whipple and Geissler 1993; Zachee et al. 1993; Haugstvedt and Husby 1999; Bohringer et al. 2002; Conca *Email: cmathoulin@orange.fr Sports Injuries DOI 10.1007/978-3-642-36801-1_52-1 # Springer-Verlag Berlin Heidelberg 2014