title: Antipronation spiral tenodesis--a surgical technique for the treatment of perilunate instability.
abstract: Perilunate dislocations involve avulsion or rupture of both intrinsic and extrinsic ligaments around the lunate. If inadequately treated, these ligaments may not heal properly, inducing a particular type of carpal instability characterized by the loss of the ability of the carpus to resist pronation torques. Six ligaments protect the carpus against excessive intracarpal pronation: long radiolunate, palmar and dorsal lunotriquetral, dorsal scapholunate, dorsal intercarpal, and palmar scaphocapitate ligaments. Collectively, these antipronation ligaments have a spiral configuration around the carpus. This article describes a technique to reconstruct this spiral arrangement of ligaments using a strip of flexor carpi radialis. To illustrate the technique, we describe 1 clinical case with a follow-up of 34 months. The so-called antipronation spiral tenodesis is only indicated if the instability is easily reducible, without cartilage damage.
authors.affiliation: Hand and Microsurgery Section, Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
authors.forename: Kin Ghee
authors.initials: KG
authors.lastname: Chee
authors.forename: Andrew Y H
authors.initials: AY
authors.lastname: Chin
authors.forename: Ee Ming
authors.initials: EM
authors.lastname: Chew
authors.forename: Marc
authors.initials: M
authors.lastname: Garcia-Elias
mesh_terms: D000328:Adult; D001696:Biomechanical Phenomena; D002348:Carpal Bones / Q000503:physiopathology; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008023:Ligaments, Articular / Q000000981:diagnostic imaging / Q000601:surgery*; D012667:Lunate Bone; D008297:Male; D011403:Pronation; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000379:methods; D053656:Tenodesis / Q000379:methods*; D014955:Wrist Joint / Q000000981:diagnostic imaging