Ligamentous reconstruction for chronic intercarpal instability

Twenty-one patients with chronic intercarpal instability were operated on an average of 13.2 months after injury or onset of symptoms. Fourteen had reconstruction via dorsal approaches by use of radial wrist extensor or other tendon graft. Seven patients were approached dorsally and palmarly, three had ligament repair, and four had reconstructions. The average follow-up was 25.4 months. Pain decreased in 85.7% of patients, although only two were pain free. Range of motion (ROM) generally decreased, and grip strength increased slightly. Radiologically, there was significant improvement on the initial postoperative roentgenograms, much of which was lost by the time the final roentgenograms were obtained. A clinical and radiologic grading system was devised to evaluate results. The average clinical grade improved from poor (26.5%) preoperatively to fair (44.4%) postoperatively. The radiologic grade remained in the poor range postoperatively, although there was some improvement from 40.4% to 45.6%.