Management of Chronic Lunotriquetral Intercarpal Ligament Injuries

The lunotriquetral (LT) interosseous ligament works in a linked equilibrium on the lunate with the scapholunate (SL) interosseous ligament. The most critical aspect involves the volar LT ligament that is associated with the volar ulnocapitate and ulnolunate ligaments, transmitting the extension moment of the triquetrum when it engages the hamate. However, other important secondary stabilizers also help to maintain the LT stability, including the radiotriquetral, radioscapholunate, and radiolunate ligaments. There are many treatment options for patients with LT injuries, including LT arthrodesis, debridement, capsulodesis, repair, and reconstruction. However, we feel that ulnar shortening osteotomy (USO) is a critical part of the treatment algorithm, given its ability to stabilize the LT articulation through the extrinsic stabilizers. We present a case in which a patient was successfully treated with an ulnar shortening osteotomy after prior attempts at arthroscopic debridement and open repair of the ligament.