Transposition of extensor retinaculum to reconstruct distal radioulnar joint dorsal ligament for treatment of distal radioulnar joint dorsal instability

Abstract

Objective To evaluate the efficacy of distal radioulnar joint (DRUJ) dorsal ligament reconstruction using extensor retinaculum transposition with triagular fibrocartilage complex (TFCC) repair and dorsal capsuloplasty for chronic DRUJ dorsal instability. Methods From October 2007 to July 2016, data of 18 patients (11 men and 7 women with a mean age of 37.4 years) were retrospectively analyzed who underwent DRUJ dorsal ligament reconstruction with extensor retinaculum transposition, DRUJ dorsal capsuloplasty, and TFCC repair for DRUJ dorsal instability. The tissue flap of extensor retinaculum was fixed at the ulnar edge of distal radius by two micro anchors after TFCC repair and dorsal capsuloplasty of the DRUJ capsule. X-ray examination of wrist was performed for all the patients after operation to identify the reduction of DRUJ. The wrist range of flexion and extension, the forearm range of rotation, and the grip strength of hand were measured. Modified Mayo wrist scores, DASH scores and visual analogue scale (VAS) were used to evaluate the function and pain of wrist and upper extremity. Results 18 patients were followed up for 12-70 months with an average period of 34 months. The stability of the DRUJ was restored in 16 patients. The other 2 cases wore long arm splint for 6 weeks after operation due to the residual instability of the DRUJ, after that the instability of DURJ were improved to grade I. The flexion and extension of wrist, the rotation of forearm were improved, but there were no significant difference comparing to those of pre-operation. The VAS, modified Mayo and DASH scores, grip strength of hand were significantly improved from preoperative 4.2±1.1, 67.4±11.2, 51.3±14.2, 16.3±3.7 kg to postoperative 0.2±0.5, 83.9±11.6, 15.9±3.2, 24.9±6.4 kg at the latest follow-up. Conclusion Extensor retinaculum transposition with TFCC repair and DRUJ dorsal capsuloplasty can effectively relieve pain and recovery stability of DRUJ, which was an effective method for chronic DRUJ dorsal instability. Key words: Carpal joints; Joint instability; Ligaments; Reconstructive surgical procedures