Management of Lunotriquetral Instability

Abstract

Symptomatic lunotriquetral interosseous ligament tears have been managed by simple arthroscopic debridement, ligamentous repair, and intercarpal arthrodesis. Ligamentous repair or grafting requires an extensile approach, and lunotriquetral joint fusion limits flexion and extension and radioulnar deviation by 14% and 25%, respectively.33 Arthroscopic ulnocarpal ligament plication, in addition to LT joint reduction and stabilization, is designed to augment the volar aspect of the LT joint. LT ligament tears are often associated with other pathology, notably ulnarcarpal ligament tears and disruption of the distal radioulnar joint.34 Furthermore, suture plication of the ulno-carpal ligaments shortens their length to act as a checkrein to excessive lunotriquetral motion perhaps similar to ulnar shortening procedures. Prestyloid recess tightening increases tension in the ulnar DRUJ capsule.