Editorial Commentary: Symptomatic Recurrent Instability of the Distal Radioulnar Joint After Triangular Fibrocartilage Complex Repair in Patients With Ulnar-Sided Wrist Pain May Be Related to Generalized Laxity.

Abstract

An unstable distal radioulnar joint can cause ulnar-sided wrist pain. Stability of the distal radioulnar joint, which varies among individuals, is dependent on the bony structure of the sigmoid notch and the surrounding soft tissues, such as the interosseous membrane, the extensor carpi ulnaris tendon, the pronator quadratus, and the deep radioulnar ligaments. In particular, avulsions of the deep radioulnar ligaments lead to instability and disturbed wrist proprioception. In patients with ulnar-sided pain, a distiction must always be made between clinical instability and generalized laxity. Treatment of instability, in most cases, is open or arthroscopically assisted repair of the triangular fibrocartilage complex. Postoperatively, while a degree of instability can return, symptoms typically do not. Symptom recurrence may be related to generalized joint laxity. Need for reoperation, with a goal of inducing stabilizing scar tissue, is based on severity of symptoms, and experience shows that cases with early onset of recurrent symptoms are more likely to require revision.