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Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry

PURPOSE: Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of th...

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Autores principales: Thillemann, Janni Kjærgaard, De Raedt, Sepp, Hansen, Torben Bæk, Munk, Bo, Stilling, Maiken
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862458/
https://www.ncbi.nlm.nih.gov/pubmed/33543376
http://dx.doi.org/10.1186/s40634-021-00329-y
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author Thillemann, Janni Kjærgaard
De Raedt, Sepp
Hansen, Torben Bæk
Munk, Bo
Stilling, Maiken
author_facet Thillemann, Janni Kjærgaard
De Raedt, Sepp
Hansen, Torben Bæk
Munk, Bo
Stilling, Maiken
author_sort Thillemann, Janni Kjærgaard
collection PubMed
description PURPOSE: Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). METHODS: In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. RESULTS: The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). CONCLUSION: In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions.
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spelling pubmed-78624582021-02-16 Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry Thillemann, Janni Kjærgaard De Raedt, Sepp Hansen, Torben Bæk Munk, Bo Stilling, Maiken J Exp Orthop Original Paper PURPOSE: Symptomatic instability of the distal radioulnar joint (DRUJ) caused by lesion of the Triangular Fibrocartilage Complex (TFCC) can be treated with a number of surgical techniques. Clinical examination of DRUJ translation is subjective and limited by inter-observer variability. The aim of this study was to compare the stabilizing effect on DRUJ translation with two different surgical methods using the Piano-key test and a new precise low-dose, non-invasive radiostereometric imaging method (AutoRSA). METHODS: In a randomized experimental study we evaluated the DRUJ translation in ten human cadaver arms (8 males, mean age 78 years) after cutting the proximal and distal TFCC insertions, and after open surgical TFCC reinsertion (n = 5) or TFCC reconstruction using a palmaris longus tendon graft ad modum Adams (n = 5). The cadaver arms were mounted in a custom-made fixture for a standardized Piano-key test. Radiostereometric images were recorded and AutoRSA software was used for image analyses. Standardised anatomical axes and coordinate systems of the forearm computer tomography bone models were applied to estimate DRUJ translation after TFCC lesions and after surgical repair. RESULTS: The DRUJ translation after cutting the proximal and distal TFCC insertions was 2.48 mm (95% CI 1.61; 3.36). Foveal TFCC reinsertion reduced DRUJ translation by 1.78 mm (95% CI 0.82; 2.74, p = 0.007), while TFCC reconstruction reduced DRUJ translation by 1.01 mm (95% CI -1.58; 3.60, p = 0.17). CONCLUSION: In conclusion, foveal TFCC reinsertion significantly decreased DRUJ translation while the stabilizing effect of Adams TFCC reconstruction was heterogeneous. This supports the clinical recommendation of TFCC reinsertion in patients suffering from symptomatic DRUJ instability due to acute fovea TFCC lesions. Springer Berlin Heidelberg 2021-02-04 /pmc/articles/PMC7862458/ /pubmed/33543376 http://dx.doi.org/10.1186/s40634-021-00329-y Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Original Paper
Thillemann, Janni Kjærgaard
De Raedt, Sepp
Hansen, Torben Bæk
Munk, Bo
Stilling, Maiken
Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
title Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
title_full Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
title_fullStr Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
title_full_unstemmed Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
title_short Distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
title_sort distal radioulnar joint stabilization with open foveal reinsertion versus tendon graft reconstruction: an experimental study using radiostereometry
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7862458/
https://www.ncbi.nlm.nih.gov/pubmed/33543376
http://dx.doi.org/10.1186/s40634-021-00329-y
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