Culp Midcarpal Reconstruction to Treat Palmar Midcarpal Instability

Midcarpal instability (MCI) is an uncommon pathology of the wrist where impaired static and dynamic restraints of the carpals predispose the proximal carpal row to uncontrolled movements associated with a characteristic and painful "clunk." Current non-operative strategies provide limited long-term benefit. Additionally, previously described surgical interventions are associated with limited mid- and long-term symptom resolution. Here, we describe a surgical technique for treating palmar MCI (PMCI) through autograft reconstruction of the radiotriquetral ligament and controlled thermal capsulorrhaphy. Our surgical intervention for a rare condition has shown lasting symptom relief and improved patient-reported outcomes in 7 patients at an average of 34 months after surgery.