Minimally Invasive Radio Lunate Imbrication Neutralisation Procedure (MIRLIN Procedure)

We present a novel, arthroscopic technique to repair, plicate, and reinforce the LRL (Long Radiolunate Ligament) in the setting of scapholunate dissociation. These techniques may also play a role in treating traumatic non-dissociative carpal instability (CIND-T).

Two arthroscopic techniques have been designed with overlapping goals which may be chosen according to surgeon preference, severity of LRL deficiency (often indicated by the degree of lunate extension), and the presence or absence of a complete SLIL dissociation with a drive through sign. Technique one involves the described MIRLIN procedure with LRL imbrication, the second technique follows the MIRLIN procedure but with LRL reinforcement.

We describe preliminary results through case studies for both iterations of the above described MIRLIN technique

• In this article we describe an arthroscopic approach to treating LRL injury as part of the spectrum of treatments for carpal instability.
• The procedure is minimally invasive, thereby avoiding the potentially destabilizing effects of traditional open carpal exposures, allows for direct visualization and incorporation of the capsuloligamentous structures into the repair, and can be used as an augment to other reparative procedures about the carpus
• The combination of arthroscopic LRL plication with vSTT reconstruction, RADiCL, and ADCLR can produce all of the important stabilizing components used in open procedures without the need for open incisions or transosseous tunnels through the carpal bones

Keywords: Arthroscopy, Minimally invasive