Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry

Journal of Experimental Orthopaedics

Maiken Stilling¹  Bo Munk²  Sepp De Raedt³  Janni Kjærgaard Thillemann⁴  Torben Bæk Hansen⁴ 

[1] Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark;Department of Orthopaedic Surgery, Aarhus University, Palle Juul-Jensens Boulevard 165, J-501, 8200, Aarhus N, Denmark;Department of Orthopaedic Surgery, Aarhus University, Palle Juul-Jensens Boulevard 165, J-501, 8200, Aarhus N, Denmark;NRT X-RAY A/S, Birkegårdsvej 16, 8361, Hasselager, Denmark;University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Lægaardvej 12, 7500, Holstebro, Denmark;Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 165, 8200, Aarhus N, Denmark;

关键词: Distal radioulnar joint;    Instability;    Radiostereometry;    Reconstruction;    Surgery;    Triangular fibrocartilage complex;   

DOI  :  10.1186/s40634-021-00329-y

来源: Springer

【 摘 要 】

PurposeSymptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability.The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA).MethodsIn a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5).The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair.ResultsThe DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17).ConclusionIn conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.

【 授权许可】

CC BY