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01-02-2016 | Original Paper

Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study

Authors: Christian K. Spies, Anja Niehoff, Frank Unglaub, Lars P. Müller, Martin F. Langer, Wolfram F. Neiss, Johannes Oppermann

Published in: International Orthopaedics | Issue 2/2016

Abstract

Purpose

We hypothesized that the re-fixation of the deep and superficial fibres of the distal radioulnar ligaments provide improved stability compared to reconstruction of the deep fibres alone.

Methods

Fourteen fresh-frozen cadaver upper extremities were used for biomechanical testing. Transosseous re-fixation of the deep fibres of the distal radioulnar ligaments alone (single mattress suture group; n = 7) was compared to the transosseous re-attachment of the deep and superficial fibres (double mattress suture group; n = 7). Cyclic load application provoked palmar translation of the radius with respect to the rigidly affixed ulna. Creep, stiffness, and hysteresis were obtained from the load-deformation curves, respectively. Testing was done in neutral forearm rotation, 60° pronation, and 60° supination.

Results

The re-fixation techniques did not differ significantly regarding the viscoelastic parameters creep, hysteresis, and stiffness. Several significant differences of one cycle to the consecutive one within each re-fixation group could be detected especially for creep and hysteresis. No significant differences between the different forearm positions could be detected for each viscoelastic parameter.

Conclusions

The re-fixation techniques did not differ significantly regarding creep, hysteresis, and stiffness. This means that the additional re-attachment of the superficial fibres may not provide greater stability to the DRUJ. Bearing in mind that the study was a cadaver examination with a limited number of specimens we may suppose that the re-attachment of the superficial fibres seem to be unnecessary. A gradual decline of creep and hysteresis from first to last loading-unloading cycle is to be expected and typical of ligaments which are viscoelastic.

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Hagert CG (1994) Distal radius fracture and the distal radioulnar joint--anatomical considerations. Handchir Mikrochir Plast Chir 26:22–26PubMed

Kleinman WB (2007) Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years. J Hand Surg [Am] 32:1086–1106. doi:10.1016/j.jhsa.2007.06.014 CrossRef

Spies CK, Müller LP, Oppermann J et al (2014) Instability of the distal radioulnar joint - an overview of clinical and radiological procedures regarding their efficacies. Handchir Mikrochir Plast Chir 46:137–150. doi:10.1055/s-0033-1363662 CrossRefPubMed

Haugstvedt J, Berger RA, Nakamura T et al (2006) Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint. J Hand Surg [Am] 31:445–451. doi:10.1016/j.jhsa.2005.11.008 CrossRef

Xu J, Tang JB (2009) In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint. J Hand Surg [Am] 34:40–45. doi:10.1016/j.jhsa.2008.08.006 CrossRef

Schuind F, An KN, Berglund L et al (1991) The distal radioulnar ligaments: a biomechanical study. J Hand Surg [Am] 16:1106–1114CrossRef

Moritomo H (2015) Open repair of the triangular fibrocartilage complex from palmar aspect. J Wrist Surg 4:2–8. doi:10.1055/s-0034-1398474 PubMedCentralCrossRefPubMed

Nakamura T, Takayama S, Horiuchi Y et al (2001) Origins and insertions of the triangular fibrocartilage complex: a histological study. J Hand Surg (Br) 26:446–454. doi:10.1054/jhsb.2001.0562 CrossRef

Moriya T, Aoki M, Iba K et al (2009) Effect of triangular ligament tears on distal radioulnar joint instability and evaluation of three clinical tests: a biomechanical study. J Hand Surg Eur Vol 34:219–223. doi:10.1177/1753193408098482 CrossRefPubMed

10.

Haugstvedt J, Berger RA, Berglund LJ et al (2002) An analysis of the constraint properties of the distal radioulnar ligament attachments to the ulna. J Hand Surg [Am] 27:61–67CrossRef

11.

Hagert E, Hagert C (2010) Understanding stability of the distal radioulnar joint through an understanding of its anatomy. Hand Clin 26:459–466. doi:10.1016/j.hcl.2010.05.002 CrossRefPubMed

12.

Gofton WT, Gordon KD, Dunning CE et al (2004) Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study. J Hand Surg [Am] 29:423–431. doi:10.1016/j.jhsa.2004.01.020 CrossRef

13.

Petersen MS, Adams BD (1993) Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg [Am] 18:328–334. doi:10.1016/0363-5023(93)90370-I CrossRef

14.

Atzei A, Luchetti R, Braidotti F (2015) Arthroscopic foveal repair of the triangular fibrocartilage complex. J Wrist Surg 4:22–30. doi:10.1055/s-0035-1544226 PubMedCentralCrossRefPubMed

15.

Farr S, Zechmann U, Ganger R et al (2015) Clinical experience with arthroscopically-assisted repair of peripheral triangular fibrocartilage complex tears in adolescents-technique and results. Int Orthop. doi:10.1007/s00264-015-2795-6

16.

Iwasaki N, Nishida K, Motomiya M et al (2011) Arthroscopic-assisted repair of avulsed triangular fibrocartilage complex to the fovea of the ulnar head: a 2- to 4-year follow-up study. Arthroscopy 27:1371–1378. doi:10.1016/j.arthro.2011.05.020 CrossRefPubMed

17.

Iwasaki N, Minami A (2009) Arthroscopically assisted re-attachment of avulsed triangular fibrocartilage complex to the fovea of the ulnar head. J Hand Surg [Am] 34:1323–1326. doi:10.1016/j.jhsa.2009.02.026

18.

Atzei A (2009) New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 34:582–591. doi:10.1177/1753193409100120 CrossRefPubMed

19.

Nakamura T, Nakao Y, Ikegami H et al (2004) Open repair of the ulnar disruption of the triangular fibrocartilage complex with double three-dimensional mattress suturing technique. Tech Hand Up Extrem Surg 8:116–123. doi:10.1097/01.bth.0000126573.05697.29 CrossRefPubMed

20.

Martineau PA, Bergeron S, Beckman L et al (2005) Reconstructive procedure for unstable radial-sided triangular fibrocartilage complex avulsions. J Hand Surg [Am] 30:727–732. doi:10.1016/j.jhsa.2005.01.006 CrossRef

21.

Chou KH, Sarris IK, Sotereanos DG (2003) Suture anchor repair of ulnar-sided triangular fibrocartilage complex tears. J Hand Surg (Br) 28:546–550CrossRef

22.

Spies CK, Müller LP, Unglaub F et al (2014) Anatomical transosseous fixation of the deep and superficial fibres of the radioulnar ligaments. Arch Orthop Trauma Surg 134:1783–1788. doi:10.1007/s00402-014-2103-8.

23.

Garcia-Elias M, Smith DE, Llusá M (2003) Surgical approach to the triangular fibrocartilage complex. Tech Hand Up Extrem Surg 7:134–140CrossRefPubMed

24.

Garcia-Elias M (2012) Clinical examination of the ulnar-sided painful wrist. In: del Piñal F (ed) Arthroscopic management of ulnar pain. Springer Berlin Heidelberg; Imprint: Springer, Berlin, Heidelberg, pp 25–44

25.

Dy CJ, Ouellette EA, Makowski AH et al (2012) Peripheral triangular fibrocartilage complex tears cause ulnocarpal instability: a biomechanical pilot study. Clin Orthop Relat Res 470:2771–2775. doi:10.1007/s11999-012-2399-z PubMedCentralCrossRefPubMed

26.

af Ekenstam F, Hagert CG (1985) Anatomical studies on the geometry and stability of the distal radio ulnar joint. Scand J Plast Reconstr Surg 19:17–25CrossRefPubMed

27.

Werner FW, Taormina JL, Sutton LG et al (2011) Structural properties of 6 forearm ligaments. J Hand Surg [Am] 36:1981–1987. doi:10.1016/j.jhsa.2011.09.026 CrossRef

28.

Pirela-Cruz MA, Goll SR, Klug M et al (1991) Stress computed tomography analysis of the distal radioulnar joint: a diagnostic tool for determining translational motion. J Hand Surg [Am] 16:75–82CrossRef

29.

Moritomo H, Kataoka T (2014) Palmar reconstruction of the triangular fibrocartilage complex for static instability of the distal radioulnar joint. Tech Hand Up Extrem Surg 18:110–115. doi:10.1097/BTH.0000000000000047 CrossRefPubMed

Title: Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study
Authors: Christian K. Spies
Anja Niehoff
Frank Unglaub
Lars P. Müller
Martin F. Langer
Wolfram F. Neiss
Johannes Oppermann
Publication date: 01-02-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 2/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-015-2986-1

At a glance: The STEP trials

Springer Medicine

Biomechanical comparison of transosseous re-fixation of the deep fibres of the distal radioulnar ligaments versus deep and superficial fibres: a cadaver study

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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