Distal radioulnar joint kinematics before surgery and 12 months following open foveal reinsertion of the triangular fibrocartilage complex: comparison with the contralateral non-injured joint

Janni K Thillemann; Sepp de Raedt; Emil T Petersen; Katriina B Puhakka; Torben B Hansen; Maiken Stilling

doi:10.2340/17453674.2022.3141

Authors

Janni K Thillemann Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning; Department of Clinical Medicine, Aarhus University; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital https://orcid.org/0000-0002-2742-7966
Sepp de Raedt AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital; NRT X-RAY A/S, Hasselager
Emil T Petersen Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning; Department of Clinical Medicine, Aarhus University; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital
Katriina B Puhakka Department of Radiology, Aarhus University Hospital; Department of Radiology, Regional Hospital Horsens
Torben B Hansen Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Gødstrup Hospital, Herning; Department of Clinical Medicine, Aarhus University https://orcid.org/0000-0003-1678-3612
Maiken Stilling Department of Clinical Medicine, Aarhus University; AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital; Department of Orthopaedic Surgery, Aarhus University, Denmark https://orcid.org/0000-0002-4530-2075

DOI:

https://doi.org/10.2340/17453674.2022.3141

Keywords:

Arthroscopy, Biomechanics, Distal Radioulnar Joint, Ligament, Radiological imaging, Triangular Fibrocartilage Complex

Abstract

Background and purpose: Foveal triangular fibrocartilage complex (TFCC) lesion may cause distal radioulnar joint (DRUJ) instability. Dynamic radiostereometry (dRSA) has been validated for objective measurement of DRUJ kinematics. We evaluated DRUJ kinematics by dRSA before surgery and 12 months following open foveal reinsertion of the TFCC in comparison with contralateral non-injured DRUJs.
Patients and methods: In a prospective cohort study, 21 patients (11 men) of mean age 34 years (22–50) with arthroscopically confirmed foveal TFCC lesion were evaluated preoperatively, and at 6 and 12 months after open foveal TFCC reinsertion with QDASH, PRWE, pain on NRS, and bilateral dRSA imaging during a patient active press test motion cycle, including a force-loaded downstroke and a release phase.
Results: Preoperatively, the force-loaded part (> 2.3 kg; 95% CI 1.6–3.0) of the press test motion cycle (from 15% to 75%) revealed a more volar position of the ulnar head in the sigmoid notch (DRUJ position ratio) and increased distance in DRUJs with foveal TFCC lesion compared with the patients’ contralateral non-injured DRUJ (p < 0.05). 6 months postoperatively, the DRUJ position was generally normalized and remained normalized at 12 months. However, the DRUJ distance remained higher on the injured side. 12 months postoperatively, patients reported less pain during activities, with improved QDASH and PRWE scores (p < 0.007).
Interpretation: DRUJ kinematics during the press test showed increased DRUJ translation to a more volar position of the ulnar head after foveal TFCC lesion compared with the contralateral non-injured DRUJs. Open foveal TFCC reinsertion had a stabilizing effect on DRUJ kinematics towards normalization, and improved patient-reported outcomes 6 and 12 months after surgery.