Reconstruction of distal radioulnar joint instability

The distal radioulnar joint has a unique architecture that simultaneously allows a wide arc of forearm rotation but requires the coordination of a primary ulnoradial ligament and secondary supporting structures to maintain stability. Office examination must focus on correlating the mechanism of the original injury, details of the patient’s symptoms related to activity, and a manual stress examination for ulnoradial instability. Surgical reconstruction of the stabilizing ligaments is an appropriate strategy if the symptoms are attributable primarily to traumatic instability and the patient has failed nonsurgical treatment. Both the primary ulnoradial ligament and secondary capsular ligaments can be anatomically reconstructed with a free tendon graft. During the rehabilitation process, remodeling of the tendon graft must take place to achieve the simultaneous goals of joint stability and full motion. Patients can be expected to return to manual labor, sports, and other demanding activities after complete graft incorporation and a conditioning program.