The RADiCL Procedure: Repair/Augmentation of Dorsal Capsular Ligaments

The dorsal intercarpal ligament (DIC) and the dorsal radiocarpal ligament (DRC) are pivotal to maintaining normal wrist biomechanics, and suspected injury to these stabilisers should be investigated when treating dorsal wrist and scapholunate interosseous ligament (SLIL) injuries. It is hypothesised that re-inserting extrinsic ligaments into the dorsal lunate via RADiCL (Repair/Augmentation of Dorsal Capsular Ligaments) procedure is an effective technique for the repair/augmentation of dorsal capsular ligaments. In this study the repairs were performed arthroscopically.

Since 2019, 28 patients have been prospectively enrolled in an observational study prior to their wrist surgery. Patients completed a baseline assessment to record preoperative patient-reported outcome measures (PROMs), range of motion and grip strength, and have been invited to repeat the assessment at regular post-operative intervals of 3, 6, 12 and 24 months.

Nine female and 19 male patients (average age 39 years) had PROMs collected preoperatively with 16 post-operative assessments at 6 months and four at 24 months at our Institute. PROMs and clinical measures were improved at both intervals compared to pre-op assessment, and were comparable. Pain during normal activities decreased from an average 49.7/100 at baseline to 20.9 at 6 months and 16.8 at the 24-month follow-up. Satisfaction increased from 14.5/100 at baseline to 71 at 6 months and 77, 24 months post operation. Results on both measures of hand function and pain, the PRWHE and QuickDASH, improved from baseline. Average Global Rating of Change scores for pain and function at 6 months were both 5 (“A good deal better”), increasing to 6 (“A great deal better”) for both at 24 months. PRWHE average scores changed from 57.6 to 23.4 at 6 months and 20 at 24 months. QuickDASH improved from 46.8 at baseline to 20.3 at 6 months and 20 at 24 months. Wrist ROM assessments were maintained or saw increases from baseline through to 6 months and 24 months. Grip strength improved from 27.2kg at baseline to 34.6kg at 24 months.

• The importance of the DIC and the DRC as critical stabilisers of the lunate has been underappreciated until relatively recently.
• The RADiCL procedure is a simple and reproducible arthroscopic or open method for recreating this important insertion into the lunate.

Keywords: Arthroscopy, Minimally invasive