Extensor Retinaculum Capsulorrhaphy and Suture Repair for Ulnocarpal and Distal Radioulnar Joint Instability: One-Year Results

Abstract

Purpose

Persistent ulnar-sided wrist pain, often because of triangular fibrocartilage complex (TFCC) tears, can lead to instability of the distal radioulnar joint (DRUJ) and the ulnocarpal joint (UCJ). Although the TFCC's role in stabilizing the DRUJ is well established, its contribution to UCJ stability has gained increasing recognition. This study evaluates the clinical outcomes of combined Herbert Sling and suture repair for (UCJ) instability secondary to TFCC tears.

Methods

Eighty-eight patients (91 wrists) with TFCC tears and UCJ instability, unresponsive to nonsurgical management, underwent combined Herbert sling (HS) and suture repair. The HS technique stabilizes both the DRUJ and UCJ by advancing an extensor retinaculum flap to the radius. Suture repair for the TFCC was performed using a commercially available all-inside-repair device. Postoperative care involved immobilization followed by structured rehabilitation. Outcomes were assessed at 6 months and 1 year and included visual analog scale pain scores, range of motion, and supination test results.

Results

Visual analog scale pain scores improved considerably from 4.5 before surgery to 1.1 at 6 months, with sustained improvement at 1 year. The flexion-extension arc decreased from 133° before surgery to 113° at 6 months but returned to 135° at 1 year. The pronation-supination arc decreased slightly from 177° to 171° at 6 months, with full recovery by 1 year. Supination testing showed a considerable improvement in UCJ stability, with 92% of wrists stable at 6 months and 87% stable at 1 year. Four wrists experienced recurrent instability between 6 months and 1 year.

Conclusions

The combined HS and suture repair effectively restores stability to both the DRUJ and UCJ in patients with TFCC-related ulnocarpal instability, considerably reducing pain and preserving range of motion. This technique provides a promising approach to the treatment of ulnocarpal instability while minimizing tissue disruption.

Type of study/level of evidence

Therapeutic IV.