RSS-Feed abonnieren
DOI: 10.1055/s-0043-1776000
Arthroscopic Thermal Shrinkage of Lunotriquetral Ligament Incomplete Tear without Triangular Fibrocartilage Complex Perforation
Funding This research was funded by a Soonchunhyang University grant.![](https://www.thieme-connect.de/media/jws/EFirst/lookinside/thumbnails/10-1055-s-0043-1776000_2300073-1.jpg)
Abstract
Background Few studies have reported the clinical results of arthroscopic debridement and thermal shrinkage for partial lunotriquetral (LT) ligament injury.
Purpose We estimated the outcomes of arthroscopic thermal shrinkage of a traumatic LT ligament incomplete tear without triangular fibrocartilage complex (TFCC) perforation.
Methods We evaluated the results of 24 patients. The mean follow-up was 16 months. Radiographs were examined for ulnar variance (UV) and radioulnar distance on a true lateral radiograph, and wrist function was assessed based on grip strength, Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) score, both pre- and postoperatively.
Results On preoperative magnetic resonance imaging (MRI), no obvious LT ligament tear was observed in any of the patients. The preoperative LT shear test was positive in 19 cases, while the LT ballottement test was positive in 18 cases and the ulnar stress test in 16 cases. Preoperatively, the average radiographic UV was 2.1 mm and the average radioulnar distance was 0.9 mm. The LT tear type was a flap tear in 22 cases and bucket handle tear in 2 cases arthroscopically. The visual analog pain scale score improved postoperatively (from 7.5 to 0.4). The average grip strength improved from 72.7% preoperatively to 89.8% postoperatively. The Mayo wrist score was excellent/good in 6/15 cases and fair in 3 cases, with the scores ranging from 68 to 87. The average DASH score improved from 36.8 to 7.
Conclusion We should be careful to differentiate LT ligament tears from TFCC lesions in the cases with ulnar wrist pain, because LT ligament tears may not be detected by MRI. Arthroscopic thermal shrinkage for traumatic LT ligament tear can be an effective treatment.
Level of Evidence Level IV.
Keywords
traumatic - triangular fibrocartilage complex tear - lunotriquetral ligament tear - arthroscopic debridement - thermal shrinkageNote
Institutional review board approval was granted by the Soonchunhyang University Bucheon Hospital (2018–07–021–006) for this study.
Publikationsverlauf
Eingereicht: 31. Mai 2023
Angenommen: 12. September 2023
Artikel online veröffentlicht:
14. März 2024
© 2024. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Viegas SF, Ballantyne G. Attritional lesions of the wrist joint. J Hand Surg Am 1987; 12 (06) 1025-1029
- 2 Murray PM, Palmer CG, Shin AY. The mechanism of ulnar-sided perilunate instability of the wrist: a cadaveric study and 6 clinical cases. J Hand Surg Am 2012; 37 (04) 721-728
- 3 Stanley JK, Trail IA. Carpal instability. J Bone Joint Surg Br 1994; 76 (05) 691-700
- 4 Lichtman DM, Noble III WH, Alexander CE. Dynamic triquetrolunate instability: case report. J Hand Surg Am 1984; 9 (02) 185-188
- 5 Mayfield JK, Johnson RP, Kilcoyne RK. Carpal dislocations: pathomechanics and progressive perilunar instability. J Hand Surg Am 1980; 5 (03) 226-241
- 6 Atkinson CT, Watson J. Lunotriquetral ligament tears. J Hand Surg Am 2012; 37 (10) 2142-2144
- 7 Ruch DS, Poehling GG. Arthroscopic management of partial scapholunate and lunotriquetral injuries of the wrist. J Hand Surg Am 1996; 21 (03) 412-417
- 8 Weiss AP, Sachar K, Glowacki KA. Arthroscopic debridement alone for intercarpal ligament tears. J Hand Surg Am 1997; 22 (02) 344-349
- 9 Lee JI, Nha KW, Lee GY, Kim BH, Kim JW, Park JW. Long-term outcomes of arthroscopic debridement and thermal shrinkage for isolated partial intercarpal ligament tears. Orthopedics 2012; 35 (08) e1204-e1209
- 10 Moskal MJ, Savoie III FH, Field LD. Arthroscopic capsulodesis of the lunotriquetral joint. Clin Sports Med 2001; 20 (01) 141-153 , ix–x
- 11 Slutsky DJ, Trevare J. Scapholunate and lunotriquetral injuries: arthroscopic and open management. Sports Med Arthrosc Rev 2014; 22 (01) 12-21
- 12 Cooney WP, Linscheid RL, Dobyns JH. Triangular fibrocartilage tears. J Hand Surg Am 1994; 19 (01) 143-154
- 13 Hudak PL, Amadio PC, Bombardier C. The Upper Extremity Collaborative Group (UECG). Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand) [corrected]. Am J Ind Med 1996; 29 (06) 602-608
- 14 Viegas SF, Patterson RM, Peterson PD. et al. Ulnar-sided perilunate instability: an anatomic and biomechanic study. J Hand Surg Am 1990; 15 (02) 268-278
- 15 Darlis NA, Weiser RW, Sotereanos DG. Partial scapholunate ligament injuries treated with arthroscopic debridement and thermal shrinkage. J Hand Surg Am 2005; 30 (05) 908-914
- 16 Kleinman WB. Physical examination of the wrist: useful provocative maneuvers. J Hand Surg Am 2015; 40 (07) 1486-1500
- 17 Ritt MJ, Linscheid RL, Cooney III WP, Berger RA, An KN. The lunotriquetral joint: kinematic effects of sequential ligament sectioning, ligament repair, and arthrodesis. J Hand Surg Am 1998; 23 (03) 432-445
- 18 Burns JE, Tanaka T, Ueno T, Nakamura T, Yoshioka H. Pitfalls that may mimic injuries of the triangular fibrocartilage and proximal intrinsic wrist ligaments at MR imaging. Radiographics 2011; 31 (01) 63-78
- 19 Ruston J, Konan S, Rubinraut E, Sorene E. Diagnostic accuracy of clinical examination and magnetic resonance imaging for common articular wrist pathology. Acta Orthop Belg 2013; 79 (04) 375-380
- 20 Lee RK, Griffith JF, Ng AW, Nung RC, Yeung DK. Wrist traction during MR arthrography improves detection of triangular fibrocartilage complex and intrinsic ligament tears and visibility of articular cartilage. AJR Am J Roentgenol 2016; 206 (01) 155-161
- 21 Suojärvi N, Haapamäki V, Lindfors N, Koskinen SK. Radiocarpal injuries: cone beam computed tomography arthrography, magnetic resonance arthrography, and arthroscopic correlation among 21 patients. Scand J Surg 2017; 106 (02) 173-179
- 22 Reagan DS, Linscheid RL, Dobyns JH. Lunotriquetral sprains. J Hand Surg Am 1984; 9 (04) 502-514
- 23 Andersson JK, Andernord D, Karlsson J, Fridén J. Efficacy of magnetic resonance imaging and clinical tests in diagnostics of wrist ligament injuries: a systematic review. Arthroscopy 2015; 31 (10) 2014-20.e2
- 24 Nicoson MC, Moran SL. Diagnosis and Treatment of Acute Lunotriquetral Ligament Injuries. Hand Clin 2015; 31 (03) 467-476
- 25 Smith DB, Carter TR, Johnson DH. High failure rate for electrothermal shrinkage of the lax anterior cruciate ligament: a multicenter follow-up past 2 years. Arthroscopy 2008; 24 (06) 637-641
- 26 Hirsh L, Sodha S, Bozentka D, Monaghan B, Steinberg D, Beredjiklian PK. Arthroscopic electrothermal collagen shrinkage for symptomatic laxity of the scapholunate interosseous ligament. J Hand Surg [Br] 2005; 30 (06) 643-647
- 27 Pirolo JM, Le W, Yao J. Effect of electrothermal treatment on nerve tissue within the triangular fibrocartilage complex, scapholunate, and lunotriquetral interosseous ligaments. Arthroscopy 2016; 32 (05) 773-778
- 28 Iwatsuki K, Tatebe M, Yamamoto M, Shinohara T, Nakamura R, Hirata H. Ulnar impaction syndrome: incidence of lunotriquetral ligament degeneration and outcome of ulnar-shortening osteotomy. J Hand Surg Am 2014; 39 (06) 1108-1113
- 29 Mirza A, Mirza JB, Shin AY, Lorenzana DJ, Lee BK, Izzo B. Isolated lunotriquetral ligament tears treated with ulnar shortening osteotomy. J Hand Surg Am 2013; 38 (08) 1492-1497
- 30 Pell IV RF, Uhl RL. Complications of thermal ablation in wrist arthroscopy. Arthroscopy 2004; 20 (Suppl. 02) 84-86