Journal of Hand Surgery European - 2026-04-14 - Journal Article; Review
Restoring balance in the distal radioulnar joint: advancements in minimally invasive surgical approaches.
Kraan GA, Arora R, Ho PC, Schep NW
Topics
Key Takeaway
Minimally invasive techniques—including arthroscopic foveal TFCC repair, suture-button suspension, and distal oblique bundle reinforcement—are supplanting open reconstruction for DRUJ instability, with growing evidence supporting early mobilization in stable repairs.
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Summary
This narrative review addresses surgical decision-making for DRUJ instability caused by foveal TFCC tears, distal oblique bundle disruption, and distal radius malunion. The authors synthesize current evidence on arthroscopic foveal repair, capsular reinforcement, tendon-graft reconstruction, and suture-button suspension constructs, organizing them within a stepwise pathoanatomic algorithm. No pooled outcome data or specific complication rates are reported; conclusions are consensus- and expert opinion-based.
Key Limitation
As a Level V narrative review without systematic search methodology or pooled data, technique recommendations reflect expert consensus rather than comparative efficacy evidence, limiting their evidentiary weight for practice change.
Original Abstract
Distal radioulnar joint (DRUJ) balance is essential for forearm rotation, load transmission, and overall wrist function. Traumatic injuries - including foveal triangular fibrocartilage complex (TFCC) tears, distal radius malunions and disruption of the distal oblique bundle - represent the most common causes of symptomatic DRUJ instability. Accurate differentiation between physiological laxity and clinically relevant instability remains challenging owing to limited reliability of physical examination and the subtle nature of soft-tissue pathology. Comprehensive assessment requires detailed anatomical understanding, structured clinical evaluation, multimodal imaging and, when indicated, diagnostic arthroscopy. Advances in minimally invasive surgical techniques have transformed the management of DRUJ instability. Arthroscopic interventions allow precise identification and treatment of TFCC lesions, enabling foveal repairs, capsular reinforcement, and tendon-graft reconstructions while minimizing soft-tissue disruption. Open yet minimally invasive procedures - including suture-button suspension constructs and distal oblique bundle reinforcement - offer additional options for restoring stability, particularly in chronic or complex cases. Treatment selection depends on underlying pathoanatomy, patient age, severity of instability and associated osseous deformities such as distal radius malunion or ulnar-positive variance. Postoperative recovery requires careful monitoring of stability, range of motion and functional progression, with growing evidence supporting shorter immobilization and early supervised mobilization in stable repairs. A stepwise algorithm integrating anatomical, clinical, radiographic and arthroscopic findings can guide decision-making and optimize outcomes. As diagnostic imaging and arthroscopic techniques continue to evolve, minimally invasive approaches will play an increasingly central role in restoring DRUJ balance, improving function and preventing long-term degenerative change. Level Evidence: V .