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The standard of care for lunotriquetral ligament injuries is evolving. An understanding of the mechanics of the lunotriquetral ligament and its role in carpal kinematics is critical when deciding how to treat these injuries. Treatment for these injuries varies from nonoperative to wrist arthroscopy with thermal capsulodesis and/or repair to reconstruction or limited arthrodesis. This article provides a review of the anatomy, pathomechanics, evaluation, and ultimately treatment of lunotriquetral ligament injuries.