Clinical outcomes of reconstruction of distal oblique bundle via tight rope in the treatment of chronic distal radioulnar joint instability

Background: Chronic distal radioulnar joint instability represents a debilitating condition that has traditionally required invasive surgical interventions. The utilization of a suture-button (TightRope) construct for distal oblique bundle reconstruction has recently emerged as a minimally invasive stabilization technique. Objectives: This investigation aimed to evaluate the clinical and functional outcomes following DOB reconstruction via TightRope in patients with chronic DRUJ instability. Patients and Methods: In this prospective interventional study, 20 patients (mean age: 29.1±7.2 y, 80% male, 60% left-sided injuries) diagnosed with chronic DRUJ instability underwent DOB reconstruction using a suture-button construct. Outcomes were assessed preoperatively and at 1, 3, 6, and 9 months postoperatively, including DASH and Mayo wrist scores, forearm pronation-supination range, wrist flexion-extension, hand grip strength, pain levels, and patient satisfaction. Results: DASH scores improved significantly from 44.5±6.7 preoperatively to 11.8±9.1 at 9 ​​​​​months (72.2% reduction; P <0.001). Mayo wrist scores increased from 49.0±6.6 to 79.5±6.5 (62.5% improvement; P <0.001). Supination range improved from 62.8±8.2 degrees to 77.6±5.2 degrees (24.8% increase; P <0.001), and hand grip strength improved from 62.3±7.7 to 88.4±4.5 (42.8% increase; P <0.001). Patient satisfaction nearly doubled (11.6±4.2 to 22.3±3.7; 92.1% increase; P <0.001). Pronation, flexion, and extension demonstrated minor, nonsignificant changes. DRUJ stability was restored in all patients, with a low complication rate. Conclusions: DOB reconstruction via TightRope provides reliable DRUJ stabilization with substantial functional improvement and minimal morbidity, representing a promising alternative to traditional reconstructive procedures.