RESUMEN
Background The dorsal intercarpal ligament (DIC) is an elegant dorsal stabilizer of the proximal carpal row, including the scaphoid's proximal pole and scapholunate joint. Along with the dorsal radiocarpal (DRC) ligament, it acts as a dorsal radioscaphoid stabilizer, with dynamism due to its ability to modify its length up to threefold by changing the angles between its V-shaped bundle morphology. The DIC ligament consistently originates from the dorsal tubercle of the triquetrum on the ulnar side. It spans transversely, attaching to the dorsal groove of the scaphoid (97-100%), lunate (75-90%), and proximal rim of the trapezium (12.5-50%), and overlapping the lunotriquetral interosseous ligament and the scapholunate interosseous ligament. Together with the DRC, Viegas et al (Viegas SF, Yamaguchi S, Boyd NL, Patterson RM. The dorsal ligaments of the wrist: anatomy, mechanical properties, and function. J Hand Surg Am 1999;24(3):456-468) proposed that this ligament complex should be called the "lateral-V construct." Anatomical Variant The authors present a unique type C variant of the DIC ligament, showing a distinct thick bundle directed at the dorsal aspect of the second metacarpal base that thus creates a "lateral-W construct." This dorsal triquetro-metacarpal 2 (dTqMC2) ligament acts as restraint to the body of the capitate and will provide enhanced stability of the dorsal midcarpal joint by limiting dorsal translation of the capitate in relation to the lunate. Clinical Relevance Our finding may contribute to the increasing knowledge of the dorsal ligament complex and its role in dorsal midcarpal instability, as well as surgical repair techniques.
RESUMEN
PURPOSE: This study aimed to compare the short-term outcomes of ACL reconstruction (ACLR) alone, ACLR with lateral tenodesis, and ACL and ALL reconstruction. METHODS: A retrospective cohort of prospectively collected data on all ACL procedures was performed at Aspetar Specialized Orthopaedic and Sports Medicine Hospital between January 2020 and January 2021. Patients were treated with ACLR alone, ACLR with lateral tenodesis, or ACLR with ALL reconstruction. The primary outcome was the subjective International Knee Documentation Committee (sIKDC) score. The secondary outcomes were the ACL Return to Sport after Injury (ACL-RSI) scores, pivot shift grade, subjective knee stability, and subjective pain on activity. RESULTS: A total of 100 cases were included. The most common technique was ACLR with lateral tenodesis (42%), followed by ACLR alone (38%) and ACL with ALL reconstruction (20%). The mean age was 28.15 years (15-60), and 94% of the patients were males. Meniscal procedures were more frequent in the ACLR alone group (65.8%). There was no association between subjective stability, sIKDC, ACL-RSI, and pivot shift grade and the three ACLR techniques while adjusting for age, sex, and concomitant meniscus procedures at six weeks, 12 weeks, six months, and nine months. However, there was a significant decrease in postoperative flexion in the ACL and ALL reconstruction group by a mean of 22° (95% CI - 40.7 - 3.4; P = 0.02) at 6 weeks compared to ACLR alone, which was not evident on later follow-ups. CONCLUSION: ACLR with/without lateral augmentation procedures yields similar subjective IKDC, ACL-RSI, pivot shift grade, and subjective knee instability at short-term follow-up. Therefore, lateral extra-articular augmentation procedures are safe to be performed.
