Front-to-Back Arthroscopic Repair of Complete Lunotriquetral Ligament Injuries: A Case Presentation and Algorithm for Arthroscopic Management of Intercarpal Ligament Injuries

The lunotriquetral intercarpal ligament (LTIL) is an important structure that equalizes the forces on the lunate imparted through the scapholunate intercarpal ligament. The extension moment of the triquetrum balances the flexion force of the scaphoid, positioning the lunate for efficient load transfer from the hand to the wrist. In contrast to the scapholunate intercarpal ligament, the LTIL is strongest volarly, with the most critical region being associated with the volar ulnocapitate ligament. Injury to the LTIL is less well understood in comparison to the scapholunate intercarpal ligament but is thought to arise from a fall on a radially deviated, flexed, and pronated wrist, or through attenuation related to ulnar impaction. The uncommon nature of this pathology has resulted in sparse literature, but it should always be considered in ulnar sided wrist pain. Arthroscopy is the gold standard tool for diagnosis, but treatments have been limited to thermal shrinkage or debridement, with reparative interventions classically being performed using an open approach. With advances in arthroscopic techniques, repairs and reconstructions are becoming possible and confer advantages such as less soft tissue stripping and accurate intra-articular joint evaluation. We demonstrate an arthroscopic repair of the volar and dorsal LTIL and propose a treatment methodology to incorporate arthroscopy into the treatment of these injuries.