Single- versus double-bundle suture button reconstruction of the forearm interosseous membrane for the chronic Essex-Lopresti lesion.

Abstract

Reconstruction of the ruptured interosseous membrane (IOM) is critical to restore forearm stability for the chronic Essex-Lopresti injury. Positive outcomes have been reported following IOM reconstruction with a single-bundle suture button (Mini-Tightrope) construct, although recent work suggests that double-bundle Mini-TightRope^® IOM reconstruction is biomechanically superior. The purpose of this study was to determine whether double-bundle Mini-TightRope^® reconstruction of the forearm IOM results in superior clinical outcomes to the single-bundle technique. Five patients with chronic Essex-Lopresti injuries treated with double-bundle Mini-TightRope^® IOM reconstruction were matched to five patients treated with single-bundle Mini-TightRope^® reconstruction. Improvement in clinical examination measures and patient-reported outcomes was compared between the groups. Results were good to excellent in all 10 patients. At final follow-up, forearm rotation was significantly better in the single-bundle group, while maintenance of ulnar variance was better in the double-bundle group. No significant differences were noted between the two groups for any other numerical outcomes, and no complications occurred. These findings suggest that while IOM reconstruction with a double-bundle Mini-TightRope^® construct results in greater resistance to proximal migration of the radius in the intermediate term, there is a modest concomitant loss of forearm rotation when compared to single-bundle reconstruction. Therapeutic Level IV.