Selection of tendon grafts for distal radioulnar ligament reconstruction and report of a modified technique

Purpose To investigate the graft length necessary to complete a distal radioulnar ligament reconstruction and assess the suitability of several tendon graft sources. Methods We measured the graft length needed to complete the distal radioulnar ligament reconstruction in 7 fresh-frozen cadaver specimens. The pure tendon lengths of 7 tendon graft sources were measured: palmaris longus, extensor indicis proprius, slips of extensor digiti minimi and abductor pollicis longus, and portions of flexor carpi ulnaris, flexor carpi radialis, and extensor carpi ulnaris. A modified technique that allows for a shorter length of graft is also described, and the suitability of each graft source for this technique was assessed. Results Themean graft lengths needed to complete the original andmodified reconstructionswere 138 mm and 89mm, respectively. The average length of the tendon graft whenmeasured as pure tendon was: palmaris longus (127 mm), slip of extensor digiti minimi (112 mm), extensor indicis proprius (100mm), partial flexor carpi radialis (87mm), slip of abductor pollicis longus (69mm), partial flexor carpi ulnaris (67 mm), and partial extensor carpi ulnaris (67 mm). The palmaris longus was too short for the original technique in the majority of specimens but was sufficient to complete themodified technique in every specimen that had a palmaris longus. Six specimens also had an extensor indicis proprius of suitable length for the modified technique. Conclusions The length of donor graft required for the modified reconstruction was significantly less than that needed for the original reconstruction. Three specimens had no donor tendons sufficiently long to complete the original technique if a pure tendon graft were used, whereas the modified technique could be completed in all specimens. Clinical relevance Many tendon graft sources in the upper extremity are of insufficient length to complete the distal radioulnar ligament reconstruction as described. A modified technique using suture anchors may be a useful alternative in such cases.