Tendon allograft interposition for failed distal ulnar resection: 2- to 14-year follow-up.

PURPOSE

To evaluate the mid- to long-term outcome of distal radioulnar interposition arthroplasty using an Achilles allograft for salvage of painful instability after distal ulnar resection.

METHODS

Twenty-six patients with an average age of 43 years were treated with Achilles tendon allograft interposition for failed distal ulnar resection. The average follow-up period was 79 months (range, 25-174 mo). Patients had an average of 2 previous procedures. All patients were evaluated clinically and radiographically. At the final follow-up, pain level, satisfaction, forearm rotation, grip strength, and Mayo Modified Wrist Score were assessed.

RESULTS

All clinical parameters demonstrated statistically significant improvement at the final follow-up. Mean patient pain scores improved from 8.1 to 1.3, and patient satisfaction scores improved by an average of 6.8 points. Preoperative and postoperative forearm rotation and grip strength measurements improved by an average of 28° in pronation, 41° in supination, and 72% in grip strength. The mean Mayo Modified Wrist Score improved from 42 to 85. Postoperative radiographs showed preservation of an adequate space between the distal radius and the resected distal ulna. No postoperative infections and no foreign body reactions relating to the allograft were observed.

CONCLUSIONS

Interposition arthroplasty with an Achilles allograft was an effective salvage procedure for the treatment of failed distal ulnar resection, preventing impingement of the ulnar stump on the radius. This procedure potentially provides a safe and reliable treatment, especially for patients who may not be candidates for implant arthroplasty.

TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.