Surgical Techniques in Nontraumatic Midcarpal Instability: Evaluating the Dorsal Capsulodesis and 3-Ligament Tenodesis Technique.

Abstract

Surgical management of midcarpal instability (MCI), also referred to as carpal instability nondissociative, remains controversial because of limited evidence on different techniques. This study aimed to assess and compare differences in patient-reported pain, hand and wrist function, satisfaction, range of motion, and return to work in patients with nontraumatic MCI who underwent surgical treatment either through dorsal wrist capsulodesis or 3-ligament tenodesis (3LT). Patients with MCI and persisting complaints after conservative therapy treated with 3LT or dorsal capsulodesis were included. Patients with posttraumatic instability were excluded. Primary endpoints included the Patient Rated Wrist Evaluation and Satisfaction with Treatment Result Questionnaire at 12 months postoperatively. All data were analyzed retrospectively. A total of 91 patients treated with dorsal capsulodesis and 21 treated with 3LT between December of 2011 and December of 2019 were included. At 12 months postoperatively, both treatment groups reported significant improvements in pain and function scores. However, at 3 months postoperatively, the dorsal capsulodesis group exhibited significantly better outcomes, followed by a greater return-to-work rate (72%) compared with the 3LT group (50%). However, the capsulodesis group demonstrated a decreased range of motion at 3 months that was restored at 12 months postoperatively. No significant difference in satisfaction with treatment was observed. Both 3LT and dorsal capsulodesis demonstrate promising results for addressing nontraumatic MCI. However, considering the quicker recovery and faster return to work associated with dorsal capsulodesis, the authors recommend favoring capsulodesis over 3LT when both surgical options are deemed suitable for the patient.