Single- versus double-bundle suture button reconstruction of the forearm interosseous membrane for the chronic Essex-Lopresti lesion

  • Michael P. Gaspar
  • Kenneth A. Kearns
  • Randall W. Culp
  • A. Lee Osterman
  • Patrick M. Kane
Original Article • ELBOW - FRACTURES



Reconstruction of the ruptured interosseous membrane (IOM) is critical to restore forearm stability for the chronic Essex-Lopresti injury. Positive outcomes have been reported following IOM reconstruction with a single-bundle suture button (Mini-Tightrope) construct, although recent work suggests that double-bundle Mini-TightRope® IOM reconstruction is biomechanically superior. The purpose of this study was to determine whether double-bundle Mini-TightRope® reconstruction of the forearm IOM results in superior clinical outcomes to the single-bundle technique.


Five patients with chronic Essex-Lopresti injuries treated with double-bundle Mini-TightRope® IOM reconstruction were matched to five patients treated with single-bundle Mini-TightRope® reconstruction. Improvement in clinical examination measures and patient-reported outcomes was compared between the groups.


Results were good to excellent in all 10 patients. At final follow-up, forearm rotation was significantly better in the single-bundle group, while maintenance of ulnar variance was better in the double-bundle group. No significant differences were noted between the two groups for any other numerical outcomes, and no complications occurred.


These findings suggest that while IOM reconstruction with a double-bundle Mini-TightRope® construct results in greater resistance to proximal migration of the radius in the intermediate term, there is a modest concomitant loss of forearm rotation when compared to single-bundle reconstruction.

Level of evidence

Therapeutic Level IV.


Forearm instability Longitudinal radioulnar dissociation Double-bundle interosseous membrane reconstruction Chronic Essex-Lopresti injury Mini-Tightrope suture button construct 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Human and animal rights

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

The patients were treated according to standard of care and did not sign an informed consent for the study.


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Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  1. 1.Philadelphia Hand to Shoulder Center, Department of Orthopedic SurgeryThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Darden School of BusinessUniversity of VirginiaCharlottesvilleUSA

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