Soft tissue stabilization for palmar midcarpal instability using a palmaris longus tendon graft

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Musculoskeletal Research

Background:

• Palmar midcarpal instability can significantly impair wrist function.
• Conservative management often fails to resolve symptomatic cases.
• Surgical stabilization is an option for recalcitrant instability.

Purpose of the Study:

• To evaluate a soft tissue stabilization technique for palmar midcarpal instability.
• To assess the efficacy of using a palmaris longus graft for wrist stabilization.
• To report functional and clinical outcomes of this surgical approach.

Main Methods:

• A dorsal approach was used to reconstruct the dorsal triquetrohamate ligament.
• A palmaris longus tendon graft was secured with bone anchors.
• Seven wrists in six patients with failed conservative treatment were followed for a mean of 28 months.

Main Results:

• Significant improvement in the Disabilities of the Arm, Shoulder, and Hand (DASH) score from 49 to 28.
• Increased grip strength from 15 to 21 kg.
• Most patients reported mild or no pain, with four returning to previous activities; however, one patient had a poor outcome, and another experienced recurrent instability.

Conclusions:

• The palmaris longus graft technique offers good medium-term results for palmar midcarpal instability.
• The procedure preserves some midcarpal mobility and reduces clunking.
• Further long-term studies with larger cohorts are recommended to validate the technique's overall benefit.