2009, Number 1
Acta Ortop Mex 2009; 23 (1)
Description of a novel arthroscopic surgical technique for radio-ulnar instability in a cadaveric model
Espinosa GA, Ramírez LG, León HSR, Sánchez GL
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ABSTRACTIntroduction: The distal radioulnar joint is subjected to two resultant loads. Axial load caused by grip and the transversal load due to the possibility of lifting weight against gravity. Therefore, instability of this joint leaves as a consequence a great functional incapacity. For this reason, numerous techniques have been described for its treatment such as Dr. Scheker’s technique, a reconstruction technique based on a logical, anatomical, biological, mechanical, and functional solution. Methods: We performed a descriptive study based in seven cadaveric models and fourteen wrists using a normal minimally invasive arthroscopic technique. The first step of the technique consisted in reproducing instability of the joint by means of a direct lesion of the dorsal fascicle of the triangular fibrocartilage complex. After this procedure, the reconstruction of the distal dorsal radioulnar ligament was carried out with a graft of palmaris longus tendon passed through the drilled tunnels in the distal methaphysis of the radio and ulna. Tunnels were performed under arthroscopic direct vision. The graft was inserted through the tunnels and then, fixed with a 2 mm. Endo-button system and a biodegradable screw of 5 mm. We measured range of motion before and after the surgery. The anterior-posterior translation test was applied on the models to measure instability of distal dorsal radioulnar joint, before, and after the surgical procedure. We performed descriptive statistics with SPPS 10.0 software. Results: The technique was performed in fourteen wrists, with a mean surgical time of 104 minutes (80-164 min). The mean range of motion in flexion was 90.1° before surgery and 90° after surgery. Mean range of motion in extension was 86° before and 88° after the procedure. This finding was significant statistically with a value of p 0.008; the rest of measurements did not reach statistic significance. Stability was achieved in 12 models and 2 had a doubtful anterior-posterior translation test. Discussion: The post-surgery extension was modified by the position and traction of the extremity in the cadaveric models. Two wrists remain unstable, by a technical defect while tensioning the graft at moment of fixation. Conclusion: Arthroscopic reconstruction for the distal dorsal radioulnar instability with a tendon graft is a technically reproducible technique. We recovered stability of the joint, and conserved range of motion in a cadaveric study.