Anatomic study of the lunotriquetral ligaments application for reconstruction surgery

Lunotriquetral ligament (LTL) injuries diagnosis and treatment have remained challenging due to limited understanding and application of its delicate anatomy. This study aimed to provide a detailed anatomical description of the LTL in the Vietnamese population, application for reconstruction surgery.

A descriptive cross-sectional study was conducted on 32 wrists from 16 fresh cadavers (9 males, 7 females). The mean age of the specimens was 73.9. Wrists were meticulously dissected under a 4X surgical loupe to fully expose the LTL complex. The dimensions of its three components-volar, proximal, and dorsal-were measured using a digital caliper. Its origin and insertion areas were clearly described. The proposed technique of LTL reconstruction was performed on two fresh wrists.

Morphometric analysis demonstrated that the volar portion was the structurally dominant component, being the longest (5.04 ± 1.10 mm) and thickest (2.12 ± 0.57 mm). In contrast, the proximal portion was the widest (8.73 ± 1.12 mm) but also the thinnest (0.94 ± 0.40 mm). The dorsal portion dimensions were 3.95±1.02 mm in length, 6.33±0.98 mm in width, and 1.22±0.16 mm in thickness. Most measurements were significantly greater in males compared to females (p < 0.05). The double V shaped bone tunnel using palmaris longus tendon autograft for LTL reconstruction was successfully demonstrated.

The volar LTL exhibits morphometric superiority over the other components, suggesting that surgical reconstruction should prioritize restoring the volar portion. Reconstruction using double bands of palmaris longus tendon with four bone tunnels would be better to re-establish the LTL anatomy and stability.