The medium term outcomes of an all-arthroscopic triangular fibrocartilage complex foveal reconstruction using tendon graft

All-Arthroscopic Foveal Triangular Fibrocartilage Complex Tendon Reconstruction

Background In symptomatic chronic injury of ulnar-sided tear of the triangular fibrocartilage complex, reconstruction techniques involving foveal reconstruction with palmaris longus tendon graft using the method described by Bain have been described with good outcomes. Description of Technique With increasing popularity of wrist arthroscopy to address various wrist pathologies, we present our technique of arthroscopic foveal reconstruction. We also include a step-by-step description of the procedure with illustrations, with aims to aid surgeons in executing it Conclusion Unlike other arthroscopic techniques described, this involves single osseous ulnar tunnel and performed completely arthroscopically, allowing an end result similar to Bain's open technique.

The optimal tension for the reconstruction of the distal radioulnar ligaments

PURPOSE

This study aimed to investigate the optimal tension for the reconstruction of the distal radioulnar ligaments (DRULs) in the treatment of the distal radioulnar joint (DRUJ) instability.

METHODS

A total of eight human cadaver upper extremities were used. First, the Tekscan sensor film system was used to measure the contact characteristics of the intact DRUJ. Following this, the DRULs were resected, and the measurement was repeated. The DRULs were then reconstructed according to Adams' procedure, and the contact forces under different initial tension were compared with that of the intact group to obtain the optimal tension. At that point, the contact force of the DRUJ was close to normal. The reliability of the obtained tension was verified by translational testing, which reflected the stability of the DRUJ.

RESULTS

In the neutral position, the contact force, area, and pressure inside DRUJ were 0.51 ± 0.10 N, 64.08 ± 11.58 mm², and 8.33 ± 2.42 kPa, respectively. After the DRULs were resected, they were 0.19 ± 0.02 N, 41.75 ± 5.01 mm², and 4.86 ± 1.06 kPa, respectively. The relationship between the tension and contact force was linear regression (Y = 0.0496x + 0.229, R² = 0.9575, P < 0.0001). According to the equation, when the tension was 3.64-7.68 N, the contact force was close to normal. There was no statistical difference in the stability of the reconstructed DRUJ under this tension compared with the intact group (P = 0.08).

CONCLUSION

By comparing the contact forces under different reconstruction tensions with the normal value, we obtained the optimal tension, which can provide the theoretical basis for the clinical treatment of chronic DRUJ instability.

Biomechanical evaluation of interference screw fixation techniques for distal radioulnar ligament reconstruction: a cadaveric experimental study

INTRODUCTION

In the reconstruction of distal radioulnar ligaments (DRULs), interference screws can be used for antegrade or retrograde fixation of grafts to the ulna. However, the biomechanics of interference screw fixation are currently unknown. This study aimed to determine the biomechanical effects of these two fixations on the distal radioulnar joint (DRUJ) in a cadaveric model and to investigate the appropriate initial tension.

MATERIALS AND METHODS

A total of 30 human cadaver upper extremities were used, and the DRULs were reconstructed according to Adams' procedure. First, eight specimens were randomly divided into two groups: antegrade and retrograde, followed by translational testing and load testing. Then, the other eight specimens were divided into the two groups above, and the contact mechanics, including forces, areas, and pressures, were measured. Finally, to investigate the appropriate initial tension, the remaining 14 specimens were fixed with interference screws under different tensions in an antegrade way, and the translational testing was repeated as before.

RESULTS

In the neutral position, antegrade fixation exhibited less translation than retrograde fixation (7.21 ± 0.17 mm versus 10.77 ± 1.68 mm, respectively). The maximum failure load was 70.45 ± 6.20 N in antegrade fixation, while that in retrograde fixation was 35.17 ± 2.95 N (P < 0.0001). Antegrade fixation exhibited a larger increase in contact force than retrograde fixation (99.72% ± 23.88% versus 28.18% ± 10.43%) (P = 0.001). The relationship between tension and displacement was nonlinear (Y = - 1.877 ln(x) + 7.94, R² = 0.868, P < 0.0001).

CONCLUSIONS

Compared with retrograde fixation, the antegrade fixation of interference screws may be a more reliable surgical technique, as it shows a higher failure load and stability. In addition, to avoid the risk of potential arthritis caused by anterograde fixation, we propose an equation to determine the appropriate initial tension in DRUL reconstruction.

Arthroscopic one-tunnel transosseous reconstruction of chronic triangular fibrocartilage complex foveal tears: outcomes in 12 patients

We report the surgical method and outcomes of a simple arthroscopic-assisted technique of repairing triangular fibrocartilage complex (TFCC) foveal injuries in 12 patients with chronic distal radioulnar joint instability. An ulnar transosseous tunnel was created with its distal exit point located 3 to 4 mm radial to the fovea. A tendon graft was cut into two parts, and both were then passed through the bone tunnel to secure the radioulnar ligament remnants back to the fovea in a 'V' shape configuration. At the final follow-up of 13 to 26 months (average 21), all patients had a reduction of wrist pain, with the mean visual analogue scale dropped from 4.6 to 1.6 out of 10. The distal radioulnar joint was completely stable in nine patients and had improved stability in three patients. The mean Mayo modified wrist scores improved from 72 to 89, and the clinical outcomes were excellent in four patients, good in seven and fair in one. No major surgical complications occurred. This simple arthroscopic one-tunnel transosseous approach is effective for chronic foveal tears of the TFCC with intact radioulnar ligament remnants.Level of evidence: IV.