Outcomes of the Adams–Berger Ligament Reconstruction for the Distal Radioulnar Joint Instability in 95 Consecutive CasesFunding None.
06 December 2018
27 February 2019
22 April 2019 (eFirst)
Objective The objective of this article is to evaluate the outcomes and complication rate for Adams–Berger anatomic reconstruction of the distal radioulnar joint (DRUJ), in addition, to determine the role of sigmoid notch anatomy on failure.
Methods We conducted a retrospective chart review to evaluate adult patients that had undergone reconstruction of the DRUJ for instability with the Adams–Berger procedure between 1998 and 2015 within our institution with > 24 months follow-up. Charts were reviewed for patient demographics, mechanism of injury, outcome, and complications.
Results Ninety-five wrists in 93 patients were included. Mean age at surgery was 37.3 years with 65.2 months follow-up. At the last follow-up, 90.8% had a stable DRUJ, 5.3% did not, and 3.4% had some laxity. Postoperatively, 75.9% described either no pain or mild pain. Grip strength increased while pronosupination decreased. Procedure success was 86.3%, as 12 patients underwent revision at 13.3 months postoperatively. Reconstructive failure was more common in females when an interference screw was utilized for tendon fixation. Age, timing of surgery, type of graft, sigmoid notch anatomy, and previous surgery did not affect revision or failure rate.
Conclusion Our findings demonstrate that Adams–Berger reconstruction of the DRUJ provides reliable long-term results with an overall success of 86% at > 5 years follow-up.
Level of evidence/Type of study This is a Level IV, therapeutic study.
KeywordsAdams–Berger procedure - DRUJ instability - distal radial ulnar joint - DRUJ reconstruction - ulnar-sided wrist pain
Institutional ethics was approved for the use of personal health data. All work was performed at the Mayo Clinic in Rochester, MN.
* These authors are co-authors as they contributed equally to this article.
- 1 Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27 (02) 243-251
- 2 Adams BD, Lawler E. Chronic instability of the distal radioulnar joint. J Am Acad Orthop Surg 2007; 15 (09) 571-575
- 3 Stuart PR, Berger RA, Linscheid RL, An KN. The dorsopalmar stability of the distal radioulnar joint. J Hand Surg Am 2000; 25 (04) 689-699
- 4 Atzei A. New trends in arthroscopic management of type 1-B TFCC injuries with DRUJ instability. J Hand Surg Eur Vol 2009; 34 (05) 582-591
- 5 Anderson ML, Larson AN, Moran SL, Cooney WP, Amrami KK, Berger RA. Clinical comparison of arthroscopic versus open repair of triangular fibrocartilage complex tears. J Hand Surg Am 2008; 33 (05) 675-682
- 6 Soreide E, Husby T, Haugstvedt JR. A long-term (20 years’) follow-up after arthroscopically assisted repair of the TFCC. J Plast Surg Hand Surg 2017; Oct; 51 (05) 296-300
- 7 Adams BD. Anatomic reconstruction of the distal radioulnar ligaments for DRUJ instability. Tech Hand Up Extrem Surg 2000; 4 (03) 154-160
- 8 Kakar S, Carlsen BT, Moran SL, Berger RA. The management of chronic distal radioulnar instability. Hand Clin 2010; 26 (04) 517-528
- 9 Zimmerman RM, Jupiter JB. Instability of the distal radioulnar joint. J Hand Surg Eur Vol 2014; 39 (07) 727-738
- 10 Houdek MT, Wagner ER, Moran SL, Berger RA. Disorders of the distal radioulnar joint. Plast Reconstr Surg 2015; 135 (01) 161-172
- 11 Tolat AR, Stanley JK, Trail IA. 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 (05) 587-594
- 12 Johnston K, Durand D, Hildebrand KA. Chronic volar distal radioulnar joint instability: joint capsular plication to restore function. Can J Surg 2009; 52 (02) 112-118
- 13 Stanley D, Herbert TJ. The Swanson ulnar head prosthesis for post-traumatic disorders of the distal radio-ulnar joint. J Hand Surg [Br] 1992; 17 (06) 682-688
- 14 Seo KN, Park MJ, Kang HJ. Anatomic reconstruction of the distal radioulnar ligament for posttraumatic distal radioulnar joint instability. Clin Orthop Surg 2009; 1 (03) 138-145
- 15 Lawler E, Adams BD. Reconstruction for DRUJ instability. Hand (N Y) 2007; 2 (03) 123-126
- 16 Adams BD, Divelbiss BJ. Reconstruction of the posttraumatic unstable distal radioulnar joint. Orthop Clin North Am 2001; 32 (02) 353-363 , x x.
- 17 Petersen MS, Adams BD. Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg Am 1993; 18 (02) 328-334
- 18 Teoh LC, Yam AK. Anatomic reconstruction of the distal radioulnar ligaments: long-term results. J Hand Surg [Br] 2005; 30 (02) 185-193
- 19 Ekdahl M, Wang JH, Ronga M, Fu FH. Graft healing in anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2008; 16 (10) 935-947
- 20 Thomopoulos S, Williams GR, Soslowsky LJ. Tendon to bone healing: differences in biomechanical, structural, and compositional properties due to a range of activity levels. J Biomech Eng 2003; 125 (01) 106-113
- 21 Thomopoulos S, Genin GM, Galatz LM. The development and morphogenesis of the tendon-to-bone insertion - what development can teach us about healing -. J Musculoskelet Neuronal Interact 2010; 10 (01) 35-45
- 22 Rodeo SA, Arnoczky SP, Torzilli PA, Hidaka C, Warren RF. Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. J Bone Joint Surg Am 1993; 75 (12) 1795-1803
- 23 Gulotta LV, Rodeo SA. Biology of autograft and allograft healing in anterior cruciate ligament reconstruction. Clin Sports Med 2007; 26 (04) 509-524
- 24 Kalson NS, Charalambous CP, Powell ES, Hearnden A, Stanley JK. Tendon graft--ulna fixation in distal radio-ulnar joint stabilisation; biomechanical comparison of three graft-bone fixation methods. Hand (N Y) 2009; 4 (03) 279-282