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. 2022 May;10(5):466-469.
doi: 10.22038/ABJS.2021.59167.2944.

Lunotriquetral Ligament Repair Using Augmented Internal Brace

Rustam Karanjia  1 , Daniel Rossiter  2 , Mohamed A Mokhtar  3   4 , A Ali Narvani  1 , Mohamed A Imam  1   5
Affiliations

Lunotriquetral Ligament Repair Using Augmented Internal Brace

Rustam Karanjia et al. Arch Bone Jt Surg. 2022 May.

Abstract

Lunotriquetral (LT) ligament tear, usually in combination with an adjacent carpal ligament injury, can result in complete LT dissociation and VISI (Volarflexed Intercalated Segment Instability). Operative techniques for the management of instability are highly variable with many described in literature, although there is little evidence to demonstrate the superiority of one definitive therapeutic technique of repair and reconstruction. In this paper, we discuss our proposed technique for performing LT ligament repair using an augmented internal brace, which addresses triquetral extension and lunate flexion. The internal brace construct also provides biomechanical superiority as it includes the augmentation of the ligament and capsule repair. We use figures and references from our case example to demonstrate this technique.

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Conflict of interest statement

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Figures

Figure 1
Figure 1
Pre-operative AP and lateral radiographs. On the lateral radiograph there is volar rotation and angulation of the lunate and the capitolunate angle, measuring approximately 50 degrees with an approximate scapholunate angle of 14 degrees, suggestive of VISI
Figure 2
Figure 2
A: A longitudinal incision is made in line with the 3rd metacarpal ray over the carpus, avoiding the SBRN (sensory branch of the radial nerve) and the DSBUN (dorsal sensory branch of the ulnar nerve). B: Ulnar flaps of the extensor retinaculum are created by dividing the septa which separate the 3rd through the 5th extensor compartments. EPL ; extensor pollicis longus ; EI ; extensor indicis ; ED ; extensor digitorum
Figure 3
Figure 3
A: The dorsal radiocarpal and intercarpal ligaments are identified and a ligament splitting capsulotomy is made (Berger’s Flap). DST : Dorsal scaphotriquetral ligament ; DRT : Dorsal radiotriquetral ligament. B: The dorsal component of the LT ligament must be inspected to determine if suitable to repair, as well as the articular surfaces of the midcarpal and radiocarpal joints
Figure 4
Figure 4
A 2-0 fiberwire is used to repair the LT stump. The fiberwire and size 1.3 mm SutureTape are loaded into a 2.5mm push-lock anchor which is inserted into the Triquetrum. The SutureTape is loaded into a second 2.5mm push-lock anchor and inserted into the lunate, creating an augmented internal brace repair (see right)
Figure 5
Figure 5
Post-operative radiographs
See this image and copyright information in PMC

References

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