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In Vivo Mechanical Function of the Distal Radial Ulnar Ligaments During Rotation of the Wrist

Published:August 12, 2020DOI:https://doi.org/10.1016/j.jhsa.2020.06.014

      Purpose

      The purpose of this study was to investigate changes in length of the volar and dorsal radioulnar ligaments (VRULs and DRULs), and the distal radioulnar joint (DRUJ) space during unweighted and weighted rotation of the wrist using magnetic resonance imaging and biplanar fluoroscopy.

      Methods

      Fourteen wrists in 7 normal adult volunteers were imaged to define the 3-dimensional geometry of the DRUJ and the insertion sites of the superficial and deep bundles of the VRULs and DRULs. Subjects were imaged at 10 positions of forearm rotation ranging from full pronation to full supination, with or without a 5-pound weight. Lengths of the superficial and deep VRUL and DRUL bundles and DRUJ space were measured (in millimeters) at each position to evaluate ligament function and DRUJ stability.

      Results

      In the unweighted and weighted trials, maximal elongation of both deep and superficial VRUL bundles occurred in supination and maximal lengths of the deep and superficial DRUL bundles occurred in pronation. Maximum DRUJ space occurred during pronation and a minimum occurred in 30° of supination. In weighted trials, there was a significant increase in deep and superficial VRUL bundle length at positions between 30° of pronation and 30° of supination; however, there was no effect of weight on DRULs length. In weighted trials, there was a significant increase in DRUJ space at positions between full pronation and 15° of supination.

      Conclusions

      This study demonstrates elongation of the VRULs in supination and the DRULs in pronation. There was no evidence of reciprocal loading of superficial/deep ligament bundles on either the dorsal or the volar aspects of the DRUJ. The effect of loading the wrist during rotation was apparent primarily in the VRULs, but not the DRULs. The DRUJ space was lowest at approximately 30° of supination.

      Clinical relevance

      These results add information to the literature regarding the complicated biomechanics of the triangular fibrocartilage complex and DRUJ. Future work should evaluate changes in biomechanics caused by triangular fibrocartilage complex tears to determine how tear severity and location relate to clinical symptoms.

      Key words

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      References

        • Henry M.H.
        Management of acute triangular fibrocartilage complex injury of the wrist.
        J Am Acad Orthop Surg. 2008; 16: 320-329
        • Ruch D.S.
        • Papadonikolakis A.
        Arthroscopically assisted repair of peripheral triangular fibrocartilage complex tears: factors affecting outcome.
        Arthroscopy. 2005; 21: 1126-1130
        • Hojo J.
        • Omokawa S.
        • Iida A.
        • Ono H.
        • Moritomo H.
        • Tanaka Y.
        Three-dimensional kinematic analysis of the distal radioulnar joint in the axial-loaded extended wrist position.
        J Hand Surg Am. 2019; 44: 336.e1-336.e6
        • Shin W.J.
        • Kim J.P.
        • Yang H.M.
        • Lee E.Y.
        • Go J.H.
        • Heo K.
        Topographical anatomy of the distal ulna attachment of the radioulnar ligament.
        J Hand Surg Am. 2017; 42: 517-524
        • Haugstvedt J.R.
        • Berger R.A.
        • Nakamura T.
        • Neale P.
        • Berglund L.
        • An K.N.
        Relative contributions of the ulnar attachments of the triangular fibrocartilage complex to the dynamic stability of the distal radioulnar joint.
        J Hand Surg Am. 2006; 31: 445-451
        • DiTano O.
        • Trumble T.E.
        • Tencer A.F.
        Biomechanical function of the distal radioulnar and ulnocarpal wrist ligaments.
        J Hand Surg Am. 2003; 28: 622-627
        • Xu J.
        • Tang J.B.
        In vivo changes in lengths of the ligaments stabilizing the distal radioulnar joint.
        J Hand Surg Am. 2009; 34: 40-45
        • Atzei A.
        • Luchetti R.
        Foveal TFCC tear classification and treatment.
        Hand Clin. 2011; 27: 263-272
        • Haugstvedt J.R.
        • Langer M.F.
        • Berger R.A.
        Distal radioulnar joint: functional anatomy, including pathomechanics.
        J Hand Surg Eur Vol. 2017; 42: 338-345
        • Kleinman W.B.
        Stability of the distal radioulna joint: biomechanics, pathophysiology, physical diagnosis, and restoration of function what we have learned in 25 years.
        J Hand Surg Am. 2007; 32: 1086-1106
        • Hagert C.G.
        Distal radius fracture and the distal radioulnar joint—anatomical considerations.
        Handchir Mikrochir Plast Chir. 1994; 26: 22-26
        • Schuind F.
        • An K.N.
        • Berglund L.
        • et al.
        The distal radioulnar ligaments: a biomechanical study.
        J Hand Surg Am. 1991; 16: 1106-1114
        • Palmer A.K.
        • Werner F.W.
        Biomechanics of the distal radioulnar joint.
        Clin Orthop Relat Res. 1984; 187: 26-35
        • An K.-N.
        • Berger R.A.
        • Cooney W.P.
        Biomechanics of the Wrist Joint.
        Springer-Verlag, New York1991
        • Stuart P.R.
        • Berger R.A.
        • Linscheid R.L.
        • An K.N.
        The dorsopalmar stability of the distal radioulnar joint.
        J Hand Surg Am. 2000; 25: 689-699
        • Watanabe H.
        • Berger R.A.
        • Berglund L.J.
        • Zobitz M.E.
        • An K.N.
        Contribution of the interosseous membrane to distal radioulnar joint constraint.
        J Hand Surg Am. 2005; 30: 1164-1171
        • Gofton W.T.
        • Gordon K.D.
        • Dunning C.E.
        • Johnson J.A.
        • King G.J.
        Soft-tissue stabilizers of the distal radioulnar joint: an in vitro kinematic study.
        J Hand Surg Am. 2004; 29: 423-431
        • Watanabe H.
        • Berger R.A.
        • An K.N.
        • Berglund L.J.
        • Zobitz M.E.
        Stability of the distal radioulnar joint contributed by the joint capsule.
        J Hand Surg Am. 2004; 29: 1114-1120
        • Ishii S.
        • Palmer A.K.
        • Werner F.W.
        • Short W.H.
        • Fortino M.D.
        An anatomic study of the ligamentous structure of the triangular fibrocartilage complex.
        J Hand Surg Am. 1998; 23: 977-985
        • Nakamura T.
        • Takayama S.
        • Horiuchi Y.
        • Yabe Y.
        Origins and insertions of the triangular fibrocartilage complex: a histological study.
        J Hand Surg Br. 2001; 26: 446-454
        • Fu E.
        • Li G.
        • Souer J.S.
        • et al.
        Elbow position affects distal radioulnar joint kinematics.
        J Hand Surg Am. 2009; 34: 1261-1268
        • Shen J.
        • Papadonikolakis A.
        • Garrett J.P.
        • Davis S.M.
        • Ruch D.S.
        Ulnar-positive variance as a predictor of distal radioulnar joint ligament disruption.
        J Hand Surg Am. 2005; 30: 1172-1177
        • Marai G.E.
        • Laidlaw D.H.
        • Demiralp C.
        • Andrews S.
        • Grimm C.M.
        • Crisco J.J.
        Estimating joint contact areas and ligament lengths from bone kinematics and surfaces.
        IEEE Trans Biomed Eng. 2004; 51: 790-799
        • Englander Z.A.
        • Martin J.T.
        • Ganapathy P.K.
        • Garrett W.E.
        • DeFrate L.E.
        Automatic registration of MRI-based joint models to high-speed biplanar radiographs for precise quantification of in vivo anterior cruciate ligament deformation during gait.
        J Biomech. 2018; 81: 36-44
        • Coleman J.L.
        • Widmyer M.R.
        • Leddy H.A.
        • et al.
        Diurnal variations in articular cartilage thickness and strain in the human knee.
        J Biomech. 2013; 46: 541-547
        • Van de Velde S.K.
        • Bingham J.T.
        • Hosseini A.
        • et al.
        Increased tibiofemoral cartilage contact deformation in patients with anterior cruciate ligament deficiency.
        Arthritis Rheum. 2009; 60: 3693-3702
        • Li G.
        • Wuerz T.H.
        • DeFrate L.E.
        Feasibility of using orthogonal fluoroscopic images to measure in vivo joint kinematics.
        J Biomech Eng. 2004; 126: 314-318
        • Li G.
        • Van de Velde S.K.
        • Bingham J.T.
        Validation of a non-invasive fluoroscopic imaging technique for the measurement of dynamic knee joint motion.
        J Biomech. 2008; 41: 1616-1622
        • Taylor K.A.
        • Cutcliffe H.C.
        • Queen R.M.
        • et al.
        In vivo measurement of ACL length and relative strain during walking.
        J Biomech. 2013; 46: 478-483
        • Abebe E.S.
        • Moorman III, C.T.
        • Dziedzic T.S.
        • et al.
        Femoral tunnel placement during anterior cruciate ligament reconstruction: an in vivo imaging analysis comparing transtibial and 2-incision tibial tunnel-independent techniques.
        Am J Sports Med. 2009; 37: 1904-1911
        • McAdams T.R.
        • Swan J.
        • Yao J.
        Arthroscopic treatment of triangular fibrocartilage wrist injuries in the athlete.
        Am J Sports Med. 2009; 37: 291-297
        • Szabo R.M.
        Distal radioulnar joint instability.
        J Bone Joint Surg Am. 2006; 88: 884-894
        • Tsai P.C.
        • Paksima N.
        The distal radioulnar joint.
        Bull NYU Hosp Jt Dis. 2009; 67: 90-96
        • Kihara H.
        • Short W.H.
        • Werner F.W.
        • Fortino M.D.
        • Palmer A.K.
        The stabilizing mechanism of the distal radioulnar joint during pronation and supination.
        J Hand Surg Am. 1995; 20: 930-936
        • Ward L.D.
        • Ambrose C.G.
        • Masson M.V.
        • Levaro F.
        The role of the distal radioulnar ligaments, interosseous membrane, and joint capsule in distal radioulnar joint stability.
        J Hand Surg Am. 2000; 25: 341-351
        • Tolat A.R.
        • Stanley J.K.
        • Trail I.A.
        A cadaveric study of the anatomy and stability of the distal radioulnar joint in the coronal and transverse planes.
        J Hand Surg Br. 1996; 21: 587-594
        • Tay S.C.
        • Berger R.A.
        • Tomita K.
        • Tan E.T.
        • Amrami K.K.
        • An K.N.
        In vivo three-dimensional displacement of the distal radioulnar joint during resisted forearm rotation.
        J Hand Surg Am. 2007; 32: 450-458