Purpose:The dorsal radiocarpal ligament (DRCL) is a secondary stabilizer of the lunate and has a role in midcarpal instability. Wrist arthroscopy through a volar portal has revealed that tears of the DRCL are more common than previously suspected, but their contribution to the pathogenesis of wrist pain has yet to be elucidated. Treatment options include observation and debridement, but arthroscopic repair may be of benefit. Methods: This study was divided into two sections. The first section consisted of an anatomic study in 5 fresh frozen cadaver arms. A volar radial arthroscopy portal was established in the floor of the flexor carpi radialis tendon sheath. An inside-out repair method was developed using meniscal suture needles introduced through a cannula adjacent to the arthroscope. A small dorsal incision was made to ensure there was no extensor tendon entrapment prior to tying the sutures. Next a clinical review of 8 patients with DRCL tears was undertaken. Results: Meniscal needles introduced arthroscopically through the DRCL exited the 4th extensor compartment in each cadaver. Three patients underwent arthroscopic repair of isolated DRCL tears followed by casting for 6 weeks, with 2/3 good results. One tear was debrided with poor results, and 4 patients underwent a dorsal capsulodesis for associated scapholunate ligament tears. Discussion: Tears of the ulnar extrinsic ligaments have been implicated as a cause of wrist pain, with treatment by arthroscopic debridement and open repair. Isolated DRCL tears in this small series were found to share similarities to ulnar extrinsic ligament tears and resulted in dorsal wrist pain in 3 patients. Impingement on the lunate by the distally displaced part of the DRCL was also observed. A initial limited arthroscopic debridement was ineffective in preventing impingement in 1 patient, which resulted in her continued wrist pain. Suturing the torn ligament edge to the capsule did prevent the impingement and relieved the wrist pain in 2/3 patients. When there was an associated scapholunate ligament tear, the treatment was primarily directed at the scapholunate instability. The dorsal incision followed by the creation of a dorsal capsular checkrein to restrain scaphoid flexion rendered any separate treatment of the DRCL tear unfeasible. The repair method as described may be effective through relieving the mechanical impingement of the unstable torn edge of the DRCL. The contribution of a DRCL tear to wrist pain in combination with additional wrist pathology is still uncertain and requires further study.