1
|
Ma HH, Wang JP, Yang CY. Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: a systematic review. J Orthop Surg Res 2024; 19:72. [PMID: 38229172 PMCID: PMC10790567 DOI: 10.1186/s13018-024-04530-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/03/2024] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Currently, there were two major surgical methods for arthroscopic triangular fibrocartilage complex (TFCC) foveal repair: suture anchor (SA) and transosseous suture (TOS). The purpose of this systematic review is to examine the relevant outcome improvement and safety of SA and TOS technique. METHODS Literature review of electronic databases for studies investigating the effects of SA and TOS in patients undergoing arthroscopic TFCC foveal repair was performed. We compared the pre-operative and postoperative functional outcomes, clinical outcomes [pain, range of motion (ROM) and grip strength], and complications of two methods. Minimal clinically important difference (MCID) was used to determine clinically meaningful improvement. RESULTS There were 1263 distinct studies identified, with 26 (904 patients) meeting the inclusion criteria. The mean age of participants ranged from 21.4 to 41 years, and the mean follow-up time ranged from 6 to 106 months. Both SA and TOS groups reported significant improvement in the modified mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, quick DASH score, patient-reported wrist evaluation (PRWE) score, and the visual analog scale (VAS) score. According to MCID, all the studies from both groups reporting DASH, quick DASH, PRWE and VAS score achieved clinically meaningful improvement. (MCID: 10 for DASH, 14 for quick DASH, 14 for PRWE and 1.6-18 for VAS). The ROM changes in both groups varied from improvement to deterioration. Grip strength improved in both SA and TOS group. Most complications were self-limited. The reoperation rates in SA and TOS ranged from 0 to 20% and 0 to 27.3%, respectively. CONCLUSIONS Both SA and TOS technique for arthroscopic TFCC foveal repair could achieve improvement in postoperative functional outcomes, pain, and grip strength with low reoperation rate. However, the ROM improvement was still inconclusive. LEVEL OF EVIDENCE IV Systematic review of level III and IV studies.
Collapse
Affiliation(s)
- Hsuan-Hsiao Ma
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Orthopaedics, Department of Surgery, Taipei Veterans General Hospital Taitung Branch, Taitung, Taiwan
- Department of Surgery, Taipei Veterans General Hospital Yuli Branch, Hualien, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chen-Yuan Yang
- Department of Orthopedic Surgery, Kuang Tien General Hospital, No. 117, Shatian Rd., Shalu Dist., Taichung City, 433, Taiwan.
- Department of Nursing, Hungkuang University, No. 1018, Sec. 6, Taiwan Blvd., Shalu Dist., Taichung City, 433, Taiwan.
| |
Collapse
|
2
|
Silber ZS, Donnelly JC, Farias MJ, Lama CJ, Luther LI, Kosinski LR, Hoy AE, Gil JA. Return to Activity After Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review. Clin J Sport Med 2023; 33:270-275. [PMID: 36728770 DOI: 10.1097/jsm.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/01/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate patients' ability to return to preinjury activity level after arthroscopically assisted triangular fibrocartilage complex (TFCC) repair. DATA SOURCES The PubMed electronic library was systematically searched from inception to August 2021 for any eligible articles using a combination of the phrases "TFCC," "return to sport," "return to work," and "athlete." RESULTS Studies that evaluated patients who had undergone arthroscopic repair of isolated TFCC injury and reported objective or patient-reported outcome measures were included. Fifteen studies representing 478 patients fulfilled the inclusion criteria. An average of 84% of patients were able to fully return to their previous work or sport activities. Most studies reported that range of motion (ROM) and grip strength (GS) both returned to >90% of the contralateral side, and every study that evaluated pain levels found a significant reduction in pain postoperatively. Mayo Modified Wrist Score was reported as excellent or good in 83% of patients, and the average Disabilities of the Arm, Shoulder, and Hand score was 13.8 postoperatively. CONCLUSION Patients were able to return to their previous work or sport activities at a high rate after TFCC repair, even those participating in more strenuous activities. Measurable functional outcomes of ROM and GS were also reliably restored to near preinjury levels. Patient-reported outcomes of pain and disability were similarly improved after TFCC repair. Current literature has established the long-term success of TFCC repair but is lacking in evaluation of the time points at which patients can expect functional status to be restored.
Collapse
Affiliation(s)
- Zachary S Silber
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Joseph C Donnelly
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Michael J Farias
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Christopher J Lama
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Lauren I Luther
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Lindsay R Kosinski
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| | - Austin E Hoy
- Baylor Scott and White Sports and Orthopedic Center, Waco, Texas
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island; and
| |
Collapse
|
3
|
McCarron L, Bindra R, Coombes BK, Bisset L. Wrist and forearm range of motion commencement time following primary triangular fibrocartilage complex foveal repair surgery: A scoping review. J Hand Ther 2021; 36:179-195. [PMID: 34972604 DOI: 10.1016/j.jht.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 08/08/2021] [Accepted: 10/02/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Scoping review. BACKGROUND Rehabilitation guidelines following triangular fibrocartilage complex (TFCC) foveal repair surgery have been inconsistently reported in the published literature, with no consensus regarding wrist or forearm range of motion (ROM) commencement time. PURPOSE OF THE STUDY To scope the available literature to identify the extent and strength of the evidence supporting the clinical guidelines for wrist and forearm ROM commencement time following primary TFCC foveal repair surgery. METHODS A systematic search produced 26 studies (3 retrospective cohort studies, 1 prospective cohort study, 1 retrospective comparative study, and 21 retrospective case series) that described specific rehabilitation protocols following TFCC foveal repair surgery. RESULTS No supporting evidence was identified regarding rehabilitation protocol recommendations across all the included studies. Postsurgery wrist ROM commencement ranged from 2 to 8 weeks; forearm ROM commencement ranged from 2 to 12 weeks. ROM commencement times did not appear to systematically influence the rate of adverse events, although adverse events were poorly reported. CONCLUSIONS TFCC rehabilitation protocols were poorly reported and varied widely between the included studies. Additional research is recommended to comprehensively evaluate the association between wrist and/or forearm ROM and the rate of adverse events for this complex and multifaceted condition.
Collapse
Affiliation(s)
- Luke McCarron
- School of Medicine and Dentistry, Griffith University, Queensland, Australia; Occupational Therapy Department, Bond University, Queensland, Australia; Orthopaedic and Trauma Department, Gold Coast Hospital and Health Service, Queensland, Australia.
| | - Randy Bindra
- School of Medicine, Griffith University, Queensland, Australia; Orthopaedic and Trauma Department, Gold Coast Hospital and Health Service, Queensland, Australia
| | - Brooke K Coombes
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| | - Leanne Bisset
- School of Medicine and Dentistry, Griffith University, Queensland, Australia
| |
Collapse
|
4
|
Kim BS, Jung KJ, Nho JH, Kim HK, Kim G. Morphologic Characteristics of the Sigmoid Notch of the Distal Radius for Patients With Peripheral Triangular Fibrocartilage Complex Tear. Orthopedics 2021; 44:e729-e734. [PMID: 34618642 DOI: 10.3928/01477447-20211001-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The distal radioulnar joint (DRUJ) is stabilized by the bony anatomy of the contact surfaces. The authors analyzed the morphologic characteristics and radiologic parameters at the sigmoid notch of patients with a peripheral triangular fibrocartilage complex (TFCC) tear compared with asymptomatic patients. Preoperative axial computed tomography scans were reviewed for 76 wrists with peripheral TFCC injuries, including foveal avulsion, and 76 wrists of age- and sex-matched control subjects. The authors used axial computed tomography scans of the DRUJ to classify the patients into 4 groups according to the type of sigmoid notch, namely, flat face, ski-slope, C-type, and S-type. They also measured the tilting angle, depth, width of the sigmoid notch, and radioulnar ratio (RUR). Statistical analyses were performed with the chi-square test or paired t test (P<.05). The mean proportions of flat face, ski-slope, C-type, and S-type sigmoid notches among patients with peripheral TFCC injuries were 42%, 22%, 29%, and 7%, respectively, whereas those for the control group were 33%, 1%, 65%, and 1%, respectively (P<.05). The tilting angle was lower (TFCC injury, 84.5°; control, 86.2°; P<.05) and the RUR was significantly higher (TFCC injury, 0.67; control, 0.56) in the TFCC group, particularly for men (P<.05). Depth (TFCC injury, 1.0 mm; control, 1.3 mm; P>.05) and width (TFCC injury, 14.8 mm; control, 14.5 mm; P>.05) were similar between the groups. Patients with ski-slope or dorsally tilted sigmoid notches may be at greater risk for peripheral TFCC injuries. [Orthopedics. 2021;44(6):e729-e734.].
Collapse
|
5
|
Hung CH, Kuo YF, Chen YJ, Yeh PC, Cho HY, Chen YJ. Comparative outcomes between all-inside arthroscopic suture anchor technique versus arthroscopic transosseous suture technique in patients with triangular fibrocartilage complex tear: a retrospective comparative study. J Orthop Surg Res 2021; 16:600. [PMID: 34649578 PMCID: PMC8515735 DOI: 10.1186/s13018-021-02752-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022] Open
Abstract
Background Triangular fibrocartilage complex (TFCC) has become an interest over the last few decades, discovering its understanding in anatomy, pathomechanism, biomechanics, and management in treatments. Currently, TFCC does not have a golden standard procedure, and not one surgical procedure is superior to the other. This study is to evaluate the comparative outcomes in TFCC patients that underwent either in all-inside arthroscopic suture anchors or the arthroscopic transosseous suture technique. Method From 2017 to 2019, 30 patients were analyzed. Eight patients were in an arthroscopic transosseous group and 22 patients were in an all-inside arthroscopic group. Comparison between patients’ flexion and extension range of motion (ROM), grip strength, and visual analog pain scale (VAS) preoperative and six-month follow-up were analyzed. Result There were significant increases in flexion ROM, extension ROM, and VAS between preoperative and postoperative in all-inside arthroscopic and arthroscopic transosseous. Only the all-inside arthroscopic group had a significant increase in grip strength. Postoperative flexion ROM had a significant difference between all-inside arthroscopic and arthroscopic transosseous. Conclusion Both the all-inside arthroscopic suture anchor technique and the arthroscopic transosseous suture technique are appropriate treatments to treat patients with TFCC. Both procedures have achieved the ultimate goal of improved longevity and optimal function. Level of evidence Level III; retrospective comparative cohort study.
Collapse
Affiliation(s)
- Chia-Hung Hung
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC
| | - Yu-Feng Kuo
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC
| | - Yu-Jen Chen
- Research and Development Center for Physical Education, Health, and Information Technology, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC
| | - Ping-Chun Yeh
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC
| | - Hsiao-Yun Cho
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.,Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, New Taipei City, 24205, Taiwan, ROC.,Department of Otorhinolaryngology, Head of Neck and Surgery, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, 24352, Taiwan, ROC
| | - Yeong-Jang Chen
- Department of Orthopedics, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, 24352, Taiwan, ROC. .,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, 24205, Taiwan, ROC.
| |
Collapse
|
6
|
Long-term results of more than 13 years after arthroscopic repair of triangular fibrocartilage complex (TFCC) Palmer 1B tears: a comparison with short- and mid-term results. Eur J Trauma Emerg Surg 2021; 48:2309-2317. [PMID: 34324007 DOI: 10.1007/s00068-021-01743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Goal of this study was the assessment of long-term outcome of arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears and the comparison with short- and mid-term results. METHODS The study included nineteen patients (mean 49.2 years of age) with a mean follow-up time of 13.6 years (13.1-14.3 years). Examination parameters included disabilities of arm, shoulder, and hand (DASH) questionnaire, modified Mayo Wrist Score (MMWS), Krimmer Score, determination of range of motion in comparison to the contralateral extremity. Grip and pinch grip strength measurement and pain level assessment was performed, as well. RESULTS The mean MMWS after at least 13.1 years was 95.8 (85-100, SD 5.6). Mean DASH Score was 10.2 (0-55.8, SD 13.6). Mean Krimmer Score was 97.2 (85-100, SD 4.8). Grip strength reached 101% of the contralateral unaffected hand. Range of motion did not differ significantly in comparison to the healthy contralateral extremity. None of the patients suffered from major complications. Fourteen of nineteen patients regarded pain level reduction as excellent. Five patients reported a relevant pain level reduction. Sixteen of nineteen patients regarded functional outcome as excellent, the other three patients reported on a pleasing improvement of the functional outcome. CONCLUSION Arthroscopically assisted repair of Palmer 1B/Atzei 1 triangular fibrocartilage complex tears may be an efficacious and safe surgical technique for ulnar-sided TFCC tears in the long term.
Collapse
|
7
|
Jung HS, Kim SH, Jung CW, Woo SJ, Kim JP, Lee JS. Arthroscopic Transosseous Repair of Foveal Tears of the Triangular Fibrocartilage Complex: A Systematic Review of Clinical Outcomes. Arthroscopy 2021; 37:1641-1650. [PMID: 33359818 DOI: 10.1016/j.arthro.2020.12.209] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 12/09/2020] [Accepted: 12/14/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether arthroscopic transosseous foveal repair of the triangular fibrocartilage complex (TFCC) results in significant and clinically relevant improvement in clinical outcomes including pain and function with low complication and reoperation rates. METHODS We reviewed studies investigating the clinical outcomes of arthroscopic transosseous foveal repair of the TFCC through MEDLINE, Embase, and the Cochrane Library. Studies on TFCC repair performed with an open or capsular technique and combined with other procedures, such as ulnar shortening osteotomy and a wafer procedure, were excluded. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies score. Clinical outcomes were assessed using range of motion, grip strength, and patient-reported outcomes. Clinically relevant improvement was determined using the minimal clinically important difference (MCID). RESULTS A total of 443 unique studies were identified, of which 7 (131 patients) met the inclusion criteria. The mean age ranged from 27 to 37 years, and the mean follow-up period ranged from 23.5 to 31.1 months. The grip strength (as a percentage) increased after foveal repair of the TFCC in all studies (mean difference range, 11.8% to 22.3%). All studies also reported an improvement in the visual analog scale score (mean difference range, -9.8 to -1.88); Modified Mayo Wrist Score (mean difference range, 10.5 to 27); and Disabilities of the Arm, Shoulder and Hand score (mean difference range, -51.8 to -24.48). Considering clinically relevant improvements based on the MCID, 4 of 5 studies reporting the visual analog scale score showed improvements in this score (MCID, 2) and all studies reporting the Disabilities of the Arm, Shoulder and Hand score showed improvements in this score (MCID, 10). Most complications recovered without any treatment, and 3 patients (2.29%) needed a reoperation. CONCLUSIONS Arthroscopic transosseous foveal repair of the TFCC resulted in improvements in grip strength and functional outcomes with low complication and reoperation rates. However, the evidence for which technique produces better clinical outcomes remains limited. LEVEL OF EVIDENCE Level IV, systematic review of Level III and IV studies.
Collapse
Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Seong Hwan Kim
- Department of Orthopaedic Surgery, Hyundae General Hospital, Namyangju-si, Republic of Korea
| | - Chan Woo Jung
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Sung Jong Woo
- Department of Orthopaedic Surgery, Guro Narsha Hospital, Seoul, Republic of Korea
| | - Jong Pil Kim
- Department of Orthopaedic Surgery, Dankook University, Cheonan, Republic of Korea
| | - Jae-Sung Lee
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Thalhammer G, Haider T, Lauffer M, Tünnerhoff HG. Mid- and Long-Term Outcome After Arthroscopically Assisted Transosseous Triangular Fibrocartilage Complex Refixation-Good to Excellent Results in Spite of Some Loss of Stability of the Distal Radioulnar Joint. Arthroscopy 2021; 37:1458-1466. [PMID: 33561484 DOI: 10.1016/j.arthro.2021.01.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 01/16/2021] [Accepted: 01/21/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate mid- and long-term outcomes after arthroscopically-assisted transosseous reattachment of the triangular fibrocartilage complex (TFCC) and to analyze the association of distal radioulnar joint (DRUJ) stability with the clinical outcome. METHODS Patients treated with an arthroscopically-assisted transosseous reattachment of the deep layer of the TFCC between 2000 and 2009 and a minimum follow-up of 12 months at mid-term and 4 years at long-term follow-up were retrospectively reviewed. Mayo Modified Wrist Score (MMWS); Disabilities of the Arm, Shoulder and Hand (DASH) score; pain visual analogue scale (VAS); grip strength and stability of the DRUJ were assessed at 2 follow-up clinical examinations. At the last follow-up, the Patient-Rated Wrist Evaluation score was additionally recorded. RESULTS Thirty patients with a mean age of 29 (±13) years were included. Most of the patients were female (70%, n = 21). The mid-term evaluation took place at a median of 30 months (range, 12-83 months). The assessed scores showed statistically significant clinical improvement (MMWS, P < .001; DASH score P < .001; VAS P < .001). Stability assessment showed a stable DRUJ in 23 (76.7%) patients. At a median of 106 months (range 52-215 months), the long-term clinical assessment was performed. The evaluated scores demonstrated persisting significant improvement (MMWS P < .001; DASH score P < .001; VAS P < .001). Stability assessment showed a stable DRUJ in 19 patients (63.3%). DRUJ instability did not correlate with clinical outcome. No permanent surgery-related complications occurred. CONCLUSION Arthroscopically-assisted transosseous reattachment of the deep fibers of radioulnar ligaments leads to excellent and good clinical results in mid- and long-term follow-up. In 95.5% of the analyzed patients, the measured improvement in the DASH score exceeded the in literature reported minimal clinically important difference of 13.5. Loss of DRUJ stability during follow-up was not associated with deterioration of clinical parameters and patient satisfaction. LEVEL OF EVIDENCE Level IV, retrospective case series.
Collapse
Affiliation(s)
- Gerhild Thalhammer
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
| | - Thomas Haider
- Department of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria; Department of Orthopedics and Traumatology, Hospital of the St. John of God Brothers Eisenstadt, Eisenstadt, Austria, Marbach, Austria
| | - Martin Lauffer
- Handchirurgische Praxis, Dr.Tünnerhoff/Dr. Lauffer, Marbach, Marbach/Neckar, Germany
| | | |
Collapse
|
9
|
Gutiérrez-Monclus R, Ferreres A, Rodríguez-Baeza A, Gutiérrez-Espinoza H. Arthroscopic triangular fibrocartilage complex repair: A biomechanical comparison of anchor and pull-out techniques in Atzei type II lesions. Sci Prog 2021; 104:368504211000888. [PMID: 33720794 PMCID: PMC10358480 DOI: 10.1177/00368504211000888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several open and arthroscopic techniques for repair triangular fibrocartilage complex (TFCC) tears have been used. The aim of this study, using a cadaveric model, was to compare the biomechanical resistance to the pronosupination movement of arthroscopic repair with anchor and pull-out techniques in TFCC tears of Atzei type II lesions. Eighteen forearms of cadaveric specimens were evaluated arthroscopically, of which 12 were selected according to the inclusion criteria. All specimens were injured with an Atzei type II lesion and were repaired arthroscopically. Six forearms were repaired using the anchor technique and the other six with the pull-out technique. To assess the biomechanical resistance of the repair, the forearms were tested to 300 cycles of 160° pronosupination. Two evaluators independently assessed the repair status every 10 cycles and the modified Desai classification was used to verify the presence of failure. The mean failure of the repair occurred at 41.6 cycles (SD 7.5) for the pull-out technique and at 28.3 cycles (SD 9.8) for the anchor technique, showing a difference of 13.3 cycles (p = 0.025) in favor of the pull-out technique. In all cases, repair failure occurred at the junction of the fibrocartilage with the suture. Arthroscopic repair with the pull-out technique showed greater biomechanical resistance to pronosupination movement in comparison to the anchor technique. Interestingly, the failure of arthroscopic repair of Atzei type II lesions occurs at the junction between the suture and the fibrocartilage.
Collapse
Affiliation(s)
| | | | | | - Héctor Gutiérrez-Espinoza
- Departamento de Ciencias Morfológicas. Facultad de Medicina. Universitat Autònoma de Barcelona. Spain
- School of Health Sciences, Physiotherapy Department, Universidad Gabriela Mistral, Santiago, Chile
| |
Collapse
|
10
|
Lee Y, Oh D, Han JH, Gong HS, Lee WW. Semiquantitative single-photon-emission computed tomography /computed tomography study to evaluate concomitant ulnar impaction syndrome in patients presenting with triangular fibrocartilage complex tears. PLoS One 2020; 15:e0244256. [PMID: 33362280 PMCID: PMC7757893 DOI: 10.1371/journal.pone.0244256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/06/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Patients presenting with tears of the triangular fibrocartilage complex (TFCC) can have ulnar positive variance, for which the clinical relevance to concomitant ulnar impaction syndrome (UIS) may be unclear. We hypothesized that maximum standardized uptake value (SUVmax), a semiquantitative single-photon-emission computed tomography/computed tomography (SPECT/CT) value, would distinguish between the traumatic TFCC tear and degenerative TFCC tear associated with the UIS. This study aimed to compare SUVmax between patients with TFCC tear only and patients with TFCC tear and UIS. Methods A total of 26 patients presenting with TFCC tears on magnetic resonance imaging (MRI) underwent semiquantitative SPECT/CT examinations. The diagnosis of concomitant UIS was made based on positive ulnar impaction tests and MRI findings. We compared the SUVmax between patients with and without concomitant UIS. We also calculated the cutoff value for the diagnosis of UIS using receiver operating characteristic curve analysis. Results Of 26 patients, 14 had concomitant UIS, and 12 had TFCC tears only. The SUVmax was significantly higher in patients with concomitant UIS than in those without UIS (p = 0.048). With a SUVmax cutoff value of 4.09 for UIS, sensitivity of 67% and specificity of 82% were obtained. Conclusions In the semiquantitative SPECT/CT examinations of patients with TFCC tears, those with concomitant UIS had a higher SUVmax than those without UIS. Semiquantitative SPECT/CT can be helpful in confirming concomitant UIS in patients with TFCC tears.
Collapse
Affiliation(s)
- Yohan Lee
- Department of Orthopaedic surgery, Seoul National University Boramae Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dongkyu Oh
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hee Han
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Sik Gong
- Department of Orthopaedic surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (HSG); (WWL)
| | - Won Woo Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
- * E-mail: (HSG); (WWL)
| |
Collapse
|
11
|
Arthroscopic Suture Repair With Additional Pronator Quadratus Advancement for the Treatment of Acute Triangular Fibrocartilage Complex Tear With Distal Radioulnar Joint Instability. Ann Plast Surg 2020; 83:411-418. [PMID: 31524734 DOI: 10.1097/sap.0000000000001982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Treatment of acute triangular fibrocartilage complex (TFCC) tear using arthroscopic suture repair has been used as a general treatment method, but it is difficult to obtain perfect results in all cases. We evaluated clinical and radiologic outcomes of the acute TFCC tear with distal radioulnar joint instability using the arthroscopic suture repair with pronator quadratus (PQ) advancement. Altogether, 80 patients (48 male, 32 female; mean ± SD age, 37.3 ± 11.5 years; mean ± SD follow-up, 23.7 ± 11.4 months) were enrolled in the study. Follow-up was at least 12 months (range, 12-38 months). Patients were divided into group 1 with arthroscopic suture repair alone (34 patients; 17 male, 17 female; mean ± SD age, 35.2 ± 10.8 years; mean ± SD follow-up, 28.1 ± 15.1 months) and group 2 with additional PQ advancement (46 patients; 29 male, 17 female; mean ± SD age, 38.9 ± 11.9 years; mean ± SD follow-up, 18.4 ± 6.2 months), and clinical and radiological assessment was performed. We also compared the ulnar translation of the injured wrist with that of the uninjured wrist using the Push Pull gauge.There was no difference in the range of motion and the grip strength between the 2 groups. However, the disabilities of the arm, shoulder, and hand score (P = 0.042) at 6-month follow-up and disabilities of the arm, shoulder, and hand score (P = 0.015) and patient-rated wrist evaluation score (P = 0.012) at 12-month follow-up were improved in group 2, and patients' satisfaction (P = 0.032) was also higher in group 2. The ulnar translation rate was also improved in group 2 at 6-month follow-up (P = 0.015) and 12-month follow-up (P = 0.045).Arthroscopic suture repair with PQ advancement provided more clinical improvement and proper stability; therefore, it will be an acceptable effective treatment option for acute TFCC tear with distal radioulnar joint instability.
Collapse
|
12
|
Kwon BC, Lee JH, Lee SY. What Is the Effect of the Ulnar-Plus Variance on the Outcomes of Arthroscopic Repair of the Peripheral Ulnar-Side Triangular Fibrocartilage Complex Tear? Arthroscopy 2020; 36:2415-2422. [PMID: 32442714 DOI: 10.1016/j.arthro.2020.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare the outcomes of arthroscopic repair of peripheral ulnar-side triangular fibrocartilage complex (TFCC) tears between patients with and without ulnar-plus variance (UPV) and to identify factors associated with index surgery failure in these patients. METHODS We retrospectively analyzed 50 consecutive patients who underwent arthroscopic repair of peripheral ulnar-side TFCC tears from June 2014 to February 2018. We selected patients who were aged at least 18 years and underwent arthroscopic repair of peripheral ulnar-side TFCC tears. We excluded those with a fractured or dislocated wrist, ulnar impaction syndrome, degenerative or inflammatory arthritis of the wrist, or neurologic conditions that affect upper-extremity function, as well as those who received less than 12 months' follow-up. We evaluated the patients with a visual analog scale for pain in 3 domains (overall, with hard work, and at rest), the Patient-rated Wrist Evaluation, range of motion, and grip strength. Clinical outcomes and arthroscopic findings were compared between patients with and without UPV (UPV group and non-UPV group, respectively). We calculated the relative risk and 95% confidence interval for younger age (<30 years), sex, UPV, and coexisting degenerative central TFCC tear (type 2 tear) to determine the risk factors for arthroscopic repair failure. RESULTS No significant differences were noted between the 2 groups regarding visual analog scale pain and Patient-rated Wrist Evaluation scores and rates of excellent or improved outcomes (P > .05). Arthroscopic repair failure was found in 4 patients. A coexisting type 2 TFCC tear was the only significant risk factor (relative risk, 49.5; 95% confidence interval, 2.94-83.96; P = .007) for arthroscopic repair failure. CONCLUSIONS UPV did not significantly affect the outcomes of arthroscopic repair of peripheral ulnar-side TFCC tears. However, coexisting type 2 TFCC tears significantly increased the risk of index surgery failure in these patients. LEVEL OF EVIDENCE Level IV, prognostic study.
Collapse
Affiliation(s)
- Bong Cheol Kwon
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
| | - Jeong Hwan Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Suk Yoon Lee
- Department of Orthopedic Surgery, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| |
Collapse
|
13
|
McNamara CT, Colakoglu S, Iorio ML. A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment. J Hand Microsurg 2020; 12:116-122. [PMID: 32788827 PMCID: PMC7410809 DOI: 10.1055/s-0040-1713580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Triangular fibrocartilage complex (TFCC) injuries can present incidentally as an asymptomatic lesion or can cause acute and chronic pain. This study compared different treatment approaches for symptomatic Palmer Type 1 TFCC injuries and rates of improvement using a systematic review of the literature. Two hundred thirty-one articles were identified, 43 met criteria and were included. Two of these articles indicated conservative therapy may be adequate. Patients who underwent debridement for any Type 1 Palmer class returned to work at a rate of 92% ( n = 182), but only 44% ( n = 38) were free of pain. For 1B lesions that underwent repair, 68.3% ( n = 226) were able to return to work and 41% ( n = 52) had persistent pain. 1D lesions were treated with both repair and debridement with similar results. Data for Types 1A and 1C were limited as no authors solely addressed these lesions. For 1A lesions, those treated with traditional treatment of debridement still had high rates of being unable to return to work. The literature remains insufficient, making comparison between studies and techniques difficult. For asymptomatic injuries, there is no need for treatment. For patients with recalcitrant symptoms, surgery improves pain, grip strength, and increases return to work and activity. The level of evidence is IV.
Collapse
Affiliation(s)
- Colin T. McNamara
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Salih Colakoglu
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| | - Matthew L. Iorio
- Division of Plastic and Reconstructive Surgery, University of Colorado Anschutz Medical Center, Aurora, Colorado, United States
| |
Collapse
|
14
|
Robba V, Fowler A, Karantana A, Grindlay D, Lindau T. Open Versus Arthroscopic Repair of 1B Ulnar-Sided Triangular Fibrocartilage Complex Tears: A Systematic Review. Hand (N Y) 2020; 15:456-464. [PMID: 30667271 PMCID: PMC7370382 DOI: 10.1177/1558944718815244] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Peripheral 1B tears of the triangular fibrocartilage complex (TFCC) can result in distal radioulnar joint (DRUJ) instability. In the context of associated DRUJ instability, combined evidence supports successful outcomes for peripheral tear repair. Methods: The aim of this systematic review (SR) was to compare the surgical treatment of 1B TFCC tears via arthroscopic versus open methods of repair. The primary outcome measure was restored DRUJ stability. The secondary outcome measures included patient-reported outcomes and clinical outcome measures. An electronic database search of Ovid Embase, PubMed, and the Cochrane Central Register of Controlled Trials was performed to cover a 20-year period. Two authors independently screened records for eligibility and extracted data. Results: Only 3 studies met the strict inclusion criteria, highlighting the poor evidence base for TFCC 1B repairs. Hence, a "secondary analysis" group was developed with modified inclusion criteria which included a further 7 studies for analysis. Pooled data from the primary and secondary analysis groups demonstrated that postoperative DRUJ stability was achieved following open repair in 84% (76/90) of cases and following arthroscopic repair in 86% (129/150) of cases. Conclusions: This SR demonstrates a current lack of high-quality evidence required to draw firm conclusions on the merits of arthroscopic versus open repair of 1B TFCC tears. There is no scientific evidence to suggest superiority of one technique over the other, albeit some surgeons and authors may express a strong personal view.
Collapse
|
15
|
Early Results of Surgical Treatment of Triangular Fibrocartilage Complex Tears in Children and Adolescents. J Hand Surg Am 2020; 45:449.e1-449.e9. [PMID: 31519316 DOI: 10.1016/j.jhsa.2019.06.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 03/24/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the clinical results and patient-reported outcomes following surgical treatment for triangular fibrocartilage complex (TFCC) tears in the pediatric and adolescent population. METHODS We reviewed 149 patients with 153 arthroscopy-confirmed TFCC tears. Mean age at surgery was 15.5 years (range, 7-19 years). There were 86 females. Plain radiographs and magnetic resonance imaging were used to characterize bony and soft tissue pathology. Mayo Modified Wrist Score (MMWS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Upper Extremity Short Form assessed functional outcomes. Median patient follow-up was 21.8 months (IQR:5.9-55.4). RESULTS Pre-operatively, all patients had wrist pain or instability with activities. The median pre-operative MMWS was 80 (interquartile range [IQR], 65-90). Fifty-six (35%) presented with positive ulnar variance. Concomitant pathology included distal radioulnar joint (DRUJ) instability (14%), ulnocarpal impaction (20%), ulnar styloid nonunion (33%), and distal radius growth arrest (30%). On arthroscopy, there were 15 (10%) isolated 1A, 79 (52%) 1B, 1 (1%) 1C, 30 (20%) 1D tears, and 25 (16%) cases of multiple tears. Twenty-six percent of wrists underwent TFCC debridement, 68% arthroscopy-assisted repair, 6% both for combined tears. Fifty-one percent of wrists underwent bony procedures-most commonly ulnar-shortening osteotomy to achieve neutral ulnar variance (40%) and symptomatic ulnar styloid nonunion excision with concomitant TFCC repair (39%). At final follow-up, pain, wrist range of motion, DRUJ stability, ulnar variance, and MMWS (median, 95 [IQR, 86.5-100]) improved significantly. The median PROMIS T-score at final follow-up was 57 (IQR, 45-57). The MMWS was better in those with concomitant bony procedures at index surgery than those with only repair or debridement of TFCC tears. CONCLUSIONS Most pediatric TFCC tears are posttraumatic and peripheral. Surgical treatment of TFCC tears and concomitant pathology in the pediatric and adolescent population results in decreased pain, improved motion and stability, and excellent functional outcomes in the majority of patients. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
|
16
|
A Novel Arthroscopic-assisted Repair of Palmer 1B Triangular Fibrocartilage Complex Tears: Early Results. Tech Orthop 2020. [DOI: 10.1097/bto.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
17
|
Sarkissian EJ, Burn MB, Yao J. Long-Term Outcomes of All-Arthroscopic Pre-Tied Suture Device Triangular Fibrocartilage Complex Repair. J Wrist Surg 2019; 8:403-407. [PMID: 31579550 PMCID: PMC6773569 DOI: 10.1055/s-0039-1688949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 04/09/2019] [Indexed: 10/26/2022]
Abstract
Background A pre-tied suture device has been utilized for all-arthroscopic peripheral triangular fibrocartilage complex (TFCC) repairs with promising early clinical results. Purpose The purpose of this study was to evaluate long-term functional outcomes of these repairs. Patients and Methods A retrospective review of patients undergoing arthroscopic TFCC repair was performed. Inclusion criteria were the Palmer type 1B TFCC tears diagnosed on arthroscopy and repaired using the all-arthroscopic pre-tied suture device. Patients with any evidence of concomitant wrist injury at the time of surgery, history of prior wrist surgery, or nonrepairable and nonperipheral TFCC tears were excluded. Postoperative complications, range of motion, grip strength, and outcome assessments were recorded for each patient. Results Eleven patients (mean age, 36 years; range, 20-64 years) satisfied our inclusion criteria and comprised the study cohort. The mean follow-up period was 7.0 years (range, 4.3-10.9 years). Mean range of motion of the wrist revealed flexion of 76 ± 11 degrees and extension of 73 ± 12 degrees. Mean grip strength was 98 ± 15% of the nonsurgical extremity. QuickDASH, modified Mayo, and patient-rated wrist evaluation (PRWE) average scores were 9 ± 8, 80 ± 6, and 12 ± 12, respectively. No surgical complications were observed and no patient required any further surgical intervention. Conclusions Our cohort of patients following all-arthroscopic pre-tied suture device repair of isolated Palmer type 1B TFCC tears demonstrated excellent clinical function at a mean follow-up of 7 years. These findings indicate that the pre-tied suture device is a reliable, safe, effective, and most importantly, durable treatment option for repair of peripheral TFCC tears. Level of Evidence This is a Level IV, therapeutic study.
Collapse
Affiliation(s)
- Eric J. Sarkissian
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
| | - Matthew B. Burn
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
| | - Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, California
| |
Collapse
|
18
|
Johnson JC, Pfeiffer FM, Jouret JE, Brogan DM. Biomechanical Analysis of Capsular Repair Versus Arthrex TFCC Ulnar Tunnel Repair for Triangular Fibrocartilage Complex Tears. Hand (N Y) 2019; 14:547-553. [PMID: 29322875 PMCID: PMC6760094 DOI: 10.1177/1558944717750920] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background: This study compares the effectiveness of a peripheral capsular repair with a knotless arthroscopic transosseous ulnar tunnel repair (TR) in restoring distal radioulnar joint (DRUJ) stability and stiffness in the setting of a massive triangular fibrocartilage complex (TFCC) tear. Methods: Eight matched pairs of fresh-frozen cadaveric forearms were tested. Each forearm was tested in supination and pronation using 3-dimensional (3D) optical tracking devices prior to any intervention. Each specimen then underwent a diagnostic wrist arthroscopy and sectioning of the TFCC's deep and superficial fibers. All specimens were then retested to assess instability secondary to the tear. The TFCC was repaired with either a peripheral capsular repair (CR) using three 2-0 polydioxanone sutures or a transosseous ulnar TR using a 2-0 FiberWire, and then retested (statistical significance; P < .05). Results: After TFCC arthroscopic sectioning, all specimens were unstable with a significant increase in translation and a significant decrease in stiffness. TFCC repair with TR resulted in displacement and stiffness similar to the native tissue. CR specimens were found to have significantly greater displacement and significantly decreased stiffness compared with the intact state. Conclusions: Arthroscopic sectioning of the TFCC resulted in DRUJ instability, as measured by stiffness and ulnar translation. TR effectively restored DRUJ stability and demonstrated no significant difference in postoperative stiffness or maximal displacement when compared with the intact specimen in pronation and supination. This study provides biomechanical evidence that an arthroscopic ulnar tunnel technique can restore stability to the DRUJ after a massive TFCC tear.
Collapse
Affiliation(s)
| | | | | | - David M. Brogan
- Washington University in St. Louis, MO,
USA,David M. Brogan, Assistant Professor,
Department of Orthopaedic Surgery, Washington University in St. Louis, 660 S.
Euclid Avenue, St. Louis, MO 63110, USA.
| |
Collapse
|
19
|
Robba VI, Karantana A, Fowler APG, Diver C. Perceptions and experiences of wrist surgeons on the management of triangular fibrocartilage complex tears: a qualitative study. J Hand Surg Eur Vol 2019; 44:572-581. [PMID: 30741080 DOI: 10.1177/1753193419826459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is lack of consensus on the management of triangular fibrocartilage injuries. The aim of this study was to investigate wrist surgeons' experiences and perceptions regarding treatment of triangular fibrocartilage complex injuries and to explore the rationale behind clinical decision-making. A purposive sample of consultant wrist surgeons (n = 10) was recruited through 'snow-balling' until data saturation was reached. Semi-structured interviews were conducted, digitally recorded and transcribed verbatim. Two researchers independently analysed data using an iterative/thematic approach. Findings suggest that surgeons rely more on their own training and experience, and patient-related factors such as individual expectations, to inform their decision-making, rather than on published material. Current classification systems are largely considered to be unhelpful. Level of evidence: V.
Collapse
Affiliation(s)
- Vanessa I Robba
- 1 Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Alexia Karantana
- 2 Centre for Evidence-Based Hand Surgery, University of Nottingham, Nottingham, UK
| | | | - Claire Diver
- 4 Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
20
|
What is the Natural History of the Triangular Fibrocartilage Complex Tear Without Distal Radioulnar Joint Instability? Clin Orthop Relat Res 2019; 477:442-449. [PMID: 30376460 PMCID: PMC6370105 DOI: 10.1097/corr.0000000000000533] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The triangular fibrocartilage complex (TFCC) tear is a common cause of ulnar-side wrist pain; however, its natural course is not well understood. QUESTIONS/PURPOSES We sought (1) to determine the natural course of TFCC tears without distal radioulnar joint (DRUJ) instability, and (2) to identify the factors associated with poor prognosis after nonsurgical treatment of TFCC tears. METHODS Over a 3-year period, we treated 117 patients with TFCC tears who did not have DRUJ instability. The diagnosis was made on the basis of ulnar-sided wrist pain, a positive ulnocarpal stress test or ulnar grinding test, and identification of a tear on MRI or CT arthrography. Of those, 25 were excluded during the initial evaluation period because they met the previously defined indications of surgery on the basis of clinical history. Another 19 patients (20%) were lost to followup before 6 months, and one patient was excluded because of prior wrist surgery, leaving 72 wrists in 72 patients for analysis in this retrospective study, which drew data from a review of electronic medical records of one institution. The group consisted of 42 men and 30 women, with a mean age of 40 years (range, 18-70 years). The study group was followed for a mean of 16 months (range, 6 to 36 months). We evaluated the pain VAS and patient-rated wrist evaluation (PRWE) at the initial visit, at 4, 8, and 12 weeks, and at more than 6 months after the initial visit. A PRWE score ≤ 20 points indicated complete recovery, and a PRWE score more than 20 points was considered an incomplete recovery. We used Kaplan-Meier survival analysis and Cox regression modelling to estimate the time to complete recovery and to identify factors associated with incomplete recovery among the seven possible factors of older age (≥ 45 years), male, obesity (body mass index ≥ 30 kg/m), dominant-hand involvement, chronic symptoms (≥ 6 months), traumatic tear, and ulnar-plus variance. RESULTS The Kaplan-Meier survival analysis showed that estimated cumulative incidence of complete recovery was 30% (95% confidence interval [CI], 20-40) at 6 months and 50% (95% CI, 39-61) at 1 year. We could not find any risk factors among the seven candidate factors, including older age (hazard ratio [HR], 0.608; 95% CI, 0.34-1.087; p = 0.093), male (HR, 1.152; 95% CI, 0.667-1.991; p = 0.612), obesity (HR, 1.433; 95% CI, 0.603-3.402; p = 0.415), dominant hand involvement (HR, 1.808; 95% CI, 0.927-3.527; p = 0.082), chronic symptoms (HR, 0.763; 95% CI, 0.443-1.922; p = 0.133), traumatic tear (HR, 0.756; 95% CI, 0.432-1.32; p = 0.325), and ulnar plus variance (HR, 0.804; 95% CI, 0.461-1.404; p = 0.443). CONCLUSIONS This study demonstrates that nonsurgical treatment is moderately successful for treating patients with TFCC tears without DRUJ instability. We recommend a minimum of 6 months nonsurgical treatment as the first-line treatment for this injury. Future studies are necessary to clarify predictors of persistent pain with nonsurgical treatment to avoid an unnecessary surgical delay. LEVEL OF EVIDENCE Level III, prognostic study.
Collapse
|
21
|
Andersson JK, Åhlén M, Andernord D. Open versus arthroscopic repair of the triangular fibrocartilage complex: a systematic review. J Exp Orthop 2018. [PMID: 29536282 PMCID: PMC5849747 DOI: 10.1186/s40634-018-0120-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and purpose To investigate the outcome of open versus arthroscopic repair of injuries of the triangular fibrocartilage complex (TFCC). Methods An electronic literature search of articles published between January 1, 1985, and May 26, 2016, in PubMed, Embase, and the Cochrane Library was carried out in May 2016 and updated in March and December 2017. Studies comparing open and arthroscopic repair of TFCC injury with a mean follow up of more than 1 year were eligible for inclusion. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist guided the extraction and reporting of data. The methodological quality of the included articles was assessed with the Cochrane Collaboration’s tool for assessing risk of bias. The primary outcome measure was the rate of postoperative distal radioulnar joint (DRUJ) re-instability. Secondary outcome measures were range of motion (ROM), grip strength, residual pain, functional wrist scores and the rates of complications and re-operations. Results A total of 868 articles were identified by the electronic search. After duplicate removal and subsequent study selection, a total of two studies were included in this systematic review. The methodological quality of the included articles displayed risks of bias. There was no difference in DRUJ re-instability between open and arthroscopic repair of the TFCC. There were no differences in obtained postoperative ROM, grip strength or values in functional outcome scores, between open and arthroscopic TFCC repair in the two included studies, except for the Disability of the Arm Shoulder and Hand (DASH) questionnaire - in favor of arthroscopic surgery - in one of the included studies. Conclusions This systematic review shows comparable results between open and arthroscopic repair of the TFCC, in terms of DRUJ re-instability and functional outcome scores. There is insufficient evidence to recommend one technique over the other in clinical practice. There is an immense lack of comparison studies with high level of evidence in the area of wrist ligament repair and reconstruction, including TFCC-injuries and DRUJ-instability.
Collapse
Affiliation(s)
- Jonny K Andersson
- Department of Hand Surgery, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden. .,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
| | - Martina Åhlén
- Department of Hand Surgery, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden.,Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Daniel Andernord
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Vårdcentralen Gripen, Karlstad, Sweden.,Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
| |
Collapse
|
22
|
Park JH, Park JW. Arthroscopic Transosseous Repair for both Proximal and Distal Components of Peripheral Triangular Fibrocartilage Complex Tear. Indian J Orthop 2018; 52:596-601. [PMID: 30532299 PMCID: PMC6241056 DOI: 10.4103/ortho.ijortho_598_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Tears of the triangular fibrocartilage complex (TFCC) can result in instability of the distal radioulnar joint (DRUJ) and ulnar-sided wrist pain. This study evaluates clinical results of arthroscopic transosseous repair for both proximal and distal components of TFCC tear with DRUJ instability. MATERIALS AND METHODS Ten patients who underwent both proximal component and distal component of TFCC repair were retrospectively reviewed. The proximal component of TFCC was repaired through arthroscopic one-tunnel transosseous suture technique, and the combined distal component tear was repaired to the ulnar capsule using same transosseous tunnel in all cases. Visual analog scale (VAS) score for pain, wrist range of motion, grip strength, and postoperative complications were evaluated after a mean followup period of 23.5 months, and each patient was rated according to modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) questionnaire. RESULTS On arthroscopic findings, the hook test confirmed the proximal component of the TFCC tear and visible capsular detachment from TFCC confirmed combined distal component tear in all patients. At final followup, 7 patients had normal stability of DRUJ and 3 patients showed mild laxity compared with the contralateral side. The mean VAS for pain perception decreased from 4.1 to 0.7, and grip strength was increased significantly. The modified Mayo wrist score and Quick DASH score showed significant functional improvement. No surgery-related complications occurred. CONCLUSIONS Arthroscopic one-tunnel transosseous TFCC foveal repair and simulatneous transosseous capsular repair of distal component can be a safe and effective strategy for repair of complete TFCC tear combined with DRUJ instability.
Collapse
Affiliation(s)
- Ji Hun Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Jong Woong Park
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Seoul, Korea,Address for correspondence: Prof. Jong Woong Park, Department of Orthopaedic Surgery, Korea University Anam Hospital, 73, Inchon-Ro, Sungbuk-Gu, Seoul 06334, Korea. E-mail:
| |
Collapse
|
23
|
Abstract
Patients suffering from ulnar-sided wrist pain after trauma may develop tenderness, clicking, a positive fovea sign, or instability of the distal radioulnar joint. If the pain is persistent, conservative treatment does not help, and the patient agrees to surgery, arthroscopy may reveal a triangular fibrocartilage complex (TFCC) injury with capsular detachment, foveal avulsion, or a combination thereof. Capsular reattachment is possible using an arthroscopic assisted technique. The reattachment can be performed with an inside-out, outside-in, or all-inside technique, providing good to excellent results, which tend to persist over time, in 60% to 90% of cases.
Collapse
Affiliation(s)
- Jan Ragnar Haugstvedt
- Hand Surgery, Department of Orthopedics, Østfold Hospital Trust, Box 300, Graalum N-1714, Norway.
| | - Endre Søreide
- Department of Orthopedic Surgery, Oslo University Hospital, Ullevål, Box 4956 Nydalen, Oslo N-0242, Norway
| |
Collapse
|
24
|
Resnik L, Borgia M, Silver B, Cancio J. Systematic Review of Measures of Impairment and Activity Limitation for Persons With Upper Limb Trauma and Amputation. Arch Phys Med Rehabil 2017; 98:1863-1892.e14. [DOI: 10.1016/j.apmr.2017.01.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 01/05/2017] [Accepted: 01/11/2017] [Indexed: 01/04/2023]
|
25
|
Soreide E, Husby T, Haugstvedt JR. A long-term (20 years') follow-up after arthroscopically assisted repair of the TFCC. J Plast Surg Hand Surg 2016; 51:296-300. [PMID: 27917687 DOI: 10.1080/2000656x.2016.1256296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The present study aimed to assess long-term functional outcome for patients after arthroscopic assisted suture for peripheral tears of the triangular fibrocartilage complex (TFCC). METHODS Eleven patients, 26 (15-59) years old at time of surgery, 48 (35-78) years old at time of follow-up, were available for this 20-year follow-up. Subjective and objective outcomes, such as range of motion, grip strength, patients' satisfaction, pain, and Mayo Modified Wrist Score, were assessed, as well as asking the question if the patients would have had the surgery done again, knowing the outcome, based on a clinical examination and patient reported questionnaires. RESULTS Median Mayo Wrist score was 85 (30-100) and, according to the Modified Mayo Wrist Score, seven patients presented good or excellent results. The patients reported median low 25 (0-66) on pain and median high 90 (1-100) on satisfaction. Ten patients presented with intact stability of the distal radioulnar joint at follow-up. Compared to the level of pain prior to surgery, two patients reported to be free of pain, five patients experienced major pain relief, two patients reported minor pain relief, while two patients reported no difference. CONCLUSIONS The findings of the present study support the trend of persisting good results for the majority of patients having undergone arthroscopically assisted repair with an outside-in suture technique for peripheral tears of the TFCC.
Collapse
Affiliation(s)
- Endre Soreide
- a Department of Orthopedic Surgery , Oslo University Hospital , Oslo , Norway
| | - Torstein Husby
- a Department of Orthopedic Surgery , Oslo University Hospital , Oslo , Norway
| | | |
Collapse
|
26
|
Die arthroskopisch unterstützte transkapsuläre Refixation des Discus triangularis am Handgelenk. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2016; 28:233-50. [DOI: 10.1007/s00064-016-0466-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 06/15/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
|
27
|
A scoping review of disabilities of the arm, shoulder, and hand scores for hand and wrist conditions. J Hand Surg Am 2014; 39:2472-80. [PMID: 25227601 DOI: 10.1016/j.jhsa.2014.07.050] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/28/2014] [Accepted: 07/29/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the variability of reported baseline Disabilities of the Arm, Shoulder, and Hand (DASH) scores for non-acute hand and wrist conditions. We hypothesized that DASH scores for evaluation of hand and wrist pathology would provide a map of scores that would correspond to severity. In addition to providing a catalog of DASH scores for various upper extremity pathologies, we hypothesized that this review would support the validity of the DASH instrument. METHODS A literature search was performed using 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials) from the earliest available date through January 1, 2013. Search terms included "DASH" and "hand" and combinations of conditions found in the initial search. The search was restricted to studies with baseline DASH scores and DASH scores for isolated conditions, and written in the English language. RESULTS Our search identified 1,770 citations; 136 full-text articles were reviewed and 85 studies were included in the scoping review. This provided 100 DASH scores mapped for 24 different diagnoses. Most articles (67%) included chronic conditions for inflammatory or degenerative pathologies rather than posttraumatic disorders. Posttraumatic DASH score reporting ranged from 4 months to 11 years after injury, and final outcome scores varied among studies assessing the same pathology. The greatest variation and highest scores were for de Quervain tendinitis (range, 29-93) and scapholunate advance collapse (range, 17-89). These scores indicated higher disability in de Quervain tendinitis and wrist osteoarthritis compared with conditions such as thumb amputation and upper extremity replantation. CONCLUSIONS Substantial variation in the DASH scores and methodology was found and indicates a need for further study of the DASH to allow for standardized interpretation. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
|
28
|
Abstract
The fields of sports medicine and performing arts medicine have begun recent initiatives to collaborate more closely and to share information pertinent to the treatment of athletes and performing artists. This article provides a review of the common musculoskeletal and neurological problems encountered among performing artists who play instruments. Approaches to history, examination, diagnosis, and treatment are offered, based on literature reviews, expert opinion, and the authors' own experiences in a musician's clinic. Treatments focus on conservative management within a multidisciplinary framework, and indications are given for appropriate surgical referral. Providers are encouraged to build an understanding of the unique issues affecting instrumental athletes.
Collapse
Affiliation(s)
- Paul T Schaefer
- Division of Sports Medicine, Department of Family Medicine and Community Health, Fellow in Primary Care Sports Medicine, University of Minnesota, Minneapolis, MN 55414, USA.
| | | |
Collapse
|
29
|
Cardenas-Montemayor E, Hartl JF, Wolf MB, Leclère FM, Dreyhaupt J, Hahn P, Unglaub F. Subjective and objective results of arthroscopic debridement of ulnar-sided TFCC (Palmer type 1B) lesions with stable distal radio-ulnar joint. Arch Orthop Trauma Surg 2013; 133:287-93. [PMID: 23143290 DOI: 10.1007/s00402-012-1643-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine functional and subjective results of patients who received arthroscopic debridement for their TFCC Palmer 1B lesions and to compare their results with those of arthroscopic suture repair. METHODS Between March 2007 and August 2011, 36 patients were diagnosed with Palmer type 1B tears and underwent arthroscopic debridement. 31 patients (15 males and 16 females) were followed up for an average of 26.7 months (±17.4 months) postoperatively. Their average age was 36.7 years (±12.7 years). Follow-up included the determination of range of motion (ROM), grip strength, pain, and wrist scores (modified Mayo wrist score (MMWS), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH score)). RESULTS Postoperative ROM averaged 99.2 % for the extension/flexion arc, 95.5 % for the radial/ulnar deviation arc, and 99.4 % for the pronation/supination arc of motion when compared with the contralateral wrist. The MMWS was rated excellent in 48 % of patients, good in 39 %, fair in 13 %, and poor in 0 %. The average DASH score was 17.02 (±14.92). There was a significant reduction in pain. The grip strength was 96.7 % (±15.8), pulp-to-pulp pinch 101.9 % (±17.4), and the ulnar variance -0.12 ± 1.69 mm. CONCLUSIONS Arthroscopic debridement of Palmer type 1B lesions in stable DRUJ yields satisfactory to excellent results. Our study showed similar results compared with the studies of arthroscopic suture repair with shorter postoperative care and fewer complications.
Collapse
|
30
|
Schädel-Höpfner M, Müller K, Gehrmann S, Lögters TT, Windolf J. [Therapy of triangular fibrocartilage complex lesions]. Unfallchirurg 2012; 115:582-8. [PMID: 22706650 DOI: 10.1007/s00113-012-2176-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The triangular fibrocartilage complex (TFCC) represents an important anatomical structure interposed between the ulnar carpus and the distal ulnar. Injuries and degenerative changes of the TFCC are of high clinical relevance and there are numerous treatment options available based on different concepts and which are being used to varying extents. The aim of this systematic review was to evaluate the effectiveness of different therapies for lesions of the TFCC. Studies on TFCC lesions were systematically reviewed, classified into evidence levels and selected according to predefined criteria. A total of 259 publications were identified as being potentially relevant and finally 35 studies could be included in the review. In addition, a survey was performed among German hand surgeons in order to identify commonly used procedures for TFCC lesions in Germany. The classification of Palmer is mostly used both in the literature and in Germany and therapeutic decisions are predominantly based on this classification. The systematic review revealed some common treatment strategies for traumatic and degenerative lesions. Generally, the level of evidence was poor for all identified publications. For this reason, evidence-based recommendations for the treatment of TFCC lesions could not be derived from the literature. There was broad consent between the results of the literature review and the survey.
Collapse
Affiliation(s)
- M Schädel-Höpfner
- Klinik für Unfall- und Handchirurgie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 4022, Düsseldorf, Deutschland.
| | | | | | | | | |
Collapse
|
31
|
Arthroscopic repair of ulnar-sided triangular fibrocartilage complex (Palmer Type 1B) tears: a comparison between short- and midterm results. J Hand Surg Am 2012; 37:2325-30. [PMID: 23101530 DOI: 10.1016/j.jhsa.2012.08.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 08/19/2012] [Accepted: 08/20/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare short- and midterm functional and subjective outcomes of arthroscopically repaired Palmer 1B tears. METHODS At 2 time points, we evaluated 49 patients with Palmer 1B tears who underwent arthroscopic repair. We examined 46 patients (23 males and 23 females) in the short-term at an average of 11 months (range, 6-23 mo) postoperatively. In a second midterm follow-up, we examined 40 patients (20 males and 20 females) an average of 4.8 years (range, 4.2-5.9 y) after repair. Between short- and midterm follow-ups, 6 patients underwent an ulnar-shortening osteotomy to alleviate persistent ulnar-sided symptoms. Objective and subjective evaluation included the determination of range of motion, grip strength, pain, and wrist scores (modified Mayo wrist score and Disabilities of Arm, Shoulder, and Hand score). RESULTS Compared with short-term repair results, midterm outcomes showed a further improvement in pain, wrist scores, grip strength, and motion. Neither static nor dynamic ulnar variance was correlated to preoperative and postoperative Disabilities of the Arm, Shoulder, and Hand scores, short-term modified Mayo wrist scores, or need for ulnar-shortening osteotomy. Five patients improved only after having received an ulnar shortening osteotomy. CONCLUSIONS After repair of Palmer 1B lesions, patients continued to improve in function and comfort at least into the second year, although some needed to have the ulna shortened to achieve this result.
Collapse
|
32
|
Wysocki RW, Richard MJ, Crowe MM, Leversedge FJ, Ruch DS. Arthroscopic treatment of peripheral triangular fibrocartilage complex tears with the deep fibers intact. J Hand Surg Am 2012; 37:509-16. [PMID: 22305741 DOI: 10.1016/j.jhsa.2011.12.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 12/06/2011] [Accepted: 12/09/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE We describe a variant of triangular fibrocartilage complex (TFCC) tears in which the superficial fibers attaching to the ulnar capsule are torn, with preservation of deep fibers inserting on the fovea. We present the clinical and magnetic resonance imaging findings and the results of arthroscopic repair in patients with this injury. METHODS Twenty-nine wrists were treated arthroscopically for peripheral TFCC tears with outside-in suture repair of the TFCC to the ulnar capsule. A retrospective review of all cases was performed to assess the physical examination, magnetic resonance imaging, and intraoperative findings. Patients were evaluated at greater than 1 year with range of motion, grip strength, standard outcome measures, and a survey assessing return to work and sports. RESULTS Before surgery, all patients had complaints of ulnar-sided wrist pain with a stable distal radioulnar joint on examination. Twenty-six wrists (90%) were available for follow-up at a mean of 31 months. There was one repeat surgery, a re-tear that required revision TFCC repair. The preoperative visual analog scale and Disabilities of the Arm, Shoulder, and Hand scores improved from 5 and 38 to 1 and 9, respectively, at final follow-up. Side-to-side comparisons demonstrated no measurable loss in motion or grip strength. There were no cases of distal radioulnar joint instability at final follow-up. Of 11 high-level athletes in the total cohort, 7 (64%) were able to return to sports, including all of those in racquet sports; however, athletes who bore weight through their hands were unable to return to their sporting activity. CONCLUSIONS Tears of the TFCC superficial fibers with the deep fibers intact present with ulnar-sided wrist pain but without distal radioulnar joint instability. The results of outside-in repair of the articular disk back to the ulnar capsule demonstrated improvement in pain and function with no measurable objective losses. Return to sport was variable and appeared worse for those who bear weight through the hands.
Collapse
|
33
|
Letter regarding "Peripheral triangular fibrocartilage complex tears". J Hand Surg Am 2011; 36:2077-8; author reply 2078. [PMID: 22123053 DOI: 10.1016/j.jhsa.2011.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 08/17/2011] [Indexed: 02/02/2023]
|
34
|
Roenbeck K, Imbriglia JE. Peripheral triangular fibrocartilage complex tears. J Hand Surg Am 2011; 36:1687-90. [PMID: 21763082 DOI: 10.1016/j.jhsa.2011.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/02/2011] [Indexed: 02/02/2023]
Affiliation(s)
- Kevin Roenbeck
- Orthopedic and Neurosurgical Specialists, LLC, Orthopedic Surgery, 807 Haddon Ave., Haddonfield, NJ 08033, USA.
| | | |
Collapse
|
35
|
Abstract
Injury to the triangular fibrocartilage complex (TFCC) is a major source of ulnar-sided wrist pain that results in disability with common activities of daily living involving forearm rotation, for which operative management is indicated if conservative management fails. Past results with open repairs have been successful, but recent surgical advances have allowed the development of arthroscopic management. This article describes and reviews an all-arthroscopic technique of repair of Palmer type IB TFCC injuries with FasT-Fix suture technology (Smith and Nephew, Andover, MA, USA), which is advantageous both biomechanically and in terms of decreasing risk of morbidity.
Collapse
|
36
|
Yao J, Lee AT. All-arthroscopic repair of Palmer 1B triangular fibrocartilage complex tears using the FasT-Fix device. J Hand Surg Am 2011; 36:836-42. [PMID: 21458928 DOI: 10.1016/j.jhsa.2011.01.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The FasT-Fix device (Smith and Nephew Endoscopy, Andover, MA), initially developed for knee meniscal tears, is described for all-arthroscopic triangular fibrocartilage complex (TFCC) repairs. Potential benefits of this technique are ease of use, the lack of prominent suture knots, and strength of repair. This case series evaluates the early clinical outcomes of this technique. METHODS We conducted a retrospective review of patients with TFCC Palmer type 1B injuries treated by 1 hand surgeon from 2005 to 2009. The patients' charts were reviewed for postoperative complications, range of motion, grip strength (percentage of contralateral), and return to full activity. In addition, each patient completed Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient-Rated Wrist Evaluation (PRWE) questionnaires. RESULTS Twelve patients had all-arthroscopic peripheral (1B) TFCC repairs using the FasT-Fix suture device. The mean follow-up period was 17.5 months (range, 11-27). Mean supination was 78° (± 14°), and mean grip strength was 64% (±16%) of the nonsurgical extremity by 3 months after surgery. All other range of motion was full. The mean QuickDASH score was 11 (±12), and the mean PRWE score was 19 (±14). Average time to full activity was 5 months. There were no surgical complications of the procedure. One patient complained of persistent ulnar-sided wrist pain 12 months after surgery and had an ulnar shortening osteotomy. Arthroscopy at the time of the osteotomy revealed that the TFCC was stable. CONCLUSIONS At mean 1-year follow-up, 11 out of 12 patients achieved excellent subjective outcomes based on QuickDASH and PRWE questionnaires. Although range of motion and grip strength were slightly decreased compared to prior case series reports, the short-term results indicate that the FasT-Fix all-arthroscopic, all-inside technique is a safe and effective technique for repair of Palmer type 1B TFCC tears.
Collapse
Affiliation(s)
- Jeffrey Yao
- Department of Orthopaedic Surgery, Stanford University Medical Center, City, Stanford, CA 94063, USA.
| | | |
Collapse
|
37
|
Unglaub F, Wolf MB, Dragu A, Hahn P. Comment on "management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening". J Hand Surg Am 2011; 36:754; author reply 755. [PMID: 21463743 DOI: 10.1016/j.jhsa.2011.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Accepted: 01/11/2011] [Indexed: 02/02/2023]
|
38
|
Papapetropoulos PA, Wartinbee DA, Richard MJ, Leversedge FJ, Ruch DS. Management of peripheral triangular fibrocartilage complex tears in the ulnar positive patient: arthroscopic repair versus ulnar shortening osteotomy. J Hand Surg Am 2010; 35:1607-13. [PMID: 20888497 DOI: 10.1016/j.jhsa.2010.06.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 06/04/2010] [Accepted: 06/08/2010] [Indexed: 02/02/2023]
Abstract
PURPOSE One pattern of injury to the triangular fibrocartilage complex (TFCC) is a traumatic peripheral tear located at the ulnar end of the TFCC. Since 1989, this specific injury has been classified as a Palmer type 1B lesion. Various treatment options have been described for 1B injuries, yet when there is coexistent ulnar positive variance, it can make the choice of treatment difficult. The purpose of this article is to help the surgeon decide how to treat type 1B lesions in ulnar positive patients by directly comparing arthroscopic repair (repair) to ulnar shortening osteotomy (USO). The null hypothesis was that repair and USO would provide equivalent postoperative improvement with regard to motion; Disability of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) score; and grip strength. METHODS We tested our hypothesis by retrospectively reviewing prospectively collected data from 51 patients treated surgically between 2000 and 2006 with type 1B tears in the setting of ulnar positive variance. Of these 51 patients, 27 were treated with arthroscopic repair and 24 with USO. All patients were evaluated before surgery as well as at final follow-up for active range of motion measurements, grip strength, DASH score, and VAS score. Radiographs were taken of all patients before surgery to confirm the presence of ulnar positive variance, and after surgery in the USO group to evaluate for bony union. RESULTS At the final follow-up, we found no statistically significant difference between the repair and USO groups with regard to flexion, extension, pronation, supination, radial deviation, or ulnar deviation. Likewise, there was no significant difference in grip strength, DASH scores, or VAS scores. When analyzing each cohort individually, both groups improved significantly after surgery with regard to DASH score, VAS score, and wrist extension. There was also a trend toward improved motion in all other directions except for an insignificant decrease in postoperative pronation in the repair group. Two patients in the USO group required additional surgery, with one revision performed for nonunion and one for painful hardware, which caused extensor carpi ulnaris tendonitis. CONCLUSIONS The results of our study suggest that type 1B TFCC tears in the ulnar positive patient can be managed equivalently well with repair or USO. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic III.
Collapse
|
39
|
Unglaub F, Thomas SB, Kroeber MW, Dragu A, Fellenberg J, Mittlmeier T, Wolf MB, Horch RE. Expression of TRAIL and death receptor DR4 in Palmer type 2 TFCC lesions. Arch Orthop Trauma Surg 2010; 130:1215-20. [PMID: 19911185 DOI: 10.1007/s00402-009-0988-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Degenerative articular disc perforations of the triangular fibrocartilage (TFC) of the wrist are characterized by fibrocartilage cell loss and are often associated with ulna-plus situations. Apoptosis has been found to play a crucial role in fibrocartilage cell loss, however, the molecular mechanism and mediators are still poorly understood. AIM The purpose of this study was to identify receptors to apoptosis in degenerative disc lesions. PATIENTS Included in the study were 17 patients with degenerative articular disc tears of the TFC (Palmer type 2C). Following arthroscopic debridement of the TFC, histological sections were examined to assess the presence of apoptosis. Apoptosis was determined using TRAIL and death receptor DR4 agonists for immunohistochemical analyses. The number of cells positive for apoptosis was then correlated with ulna length. RESULTS Cells positive for TRAIL and DR4 were found in all specimens. The number of cells positive for TRAIL was significantly increased in specimens of patients with an ulna positive variance (P = 0.040). However, DR4 was not significantly increased in ulna plus (P > 0.05). Both, TRAIL and DR4 positive cells were found to be evenly distributed throughout each specimen. There was no accumulation of any type of cells in any particular zone of the biopsies. CONCLUSION This is the first study that shows that TFCC cells express TRAIL and DR4, which suggests that apoptosis, as well as, mechanical trauma are involved in the development of disc perforation. The TRAIL/DR4 receptor system is a molecular mediator of apoptosis induction in TFC cells and therefore plays a role in cell loss in degenerative disc lesions.
Collapse
Affiliation(s)
- Frank Unglaub
- Department of Plastic and Hand Surgery, University Erlangen, Krankenhausstrasse 12, Erlangen, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
40
|
Yao J. All-Arthroscopic Repair of Peripheral Triangular Fibrocartilage Complex Tears. OPER TECHN SPORT MED 2010. [DOI: 10.1053/j.otsm.2010.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
41
|
Unglaub F, Thomas SB, Wolf MB, Dragu A, Kroeber MW, Mittlmeier T, Horch RE. Cartilage cell proliferation in degenerative TFCC wrist lesions. Arch Orthop Trauma Surg 2010; 130:953-6. [PMID: 19415312 DOI: 10.1007/s00402-009-0883-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2009] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The central zone of the triangular fibrocartilage complex (TFCC) of the wrist is thought to be avascular and is generally considered to lack any healing potential. AIM The purpose of this study was to investigate, if cartilage cells of degenerative disc lesions possess any healing or proliferation potential and whether ulna length plays a significant role in the proliferation process. RESULTS Cells positive for proliferating cell nuclear antigen (PCNA) were found in all specimens. Specimens of patients with ulna positive variance showed a decreased number of PCNA positive cells than specimens of patients with either negative or neutral ulna variance. CONCLUSION We found that cartilage cells of Palmer type 2C lesions undergo mitotic cell division, thus exhibiting proliferation capability. It could not be shown that ulnar length is significantly correlated with the number of PCNA positive cells.
Collapse
Affiliation(s)
- Frank Unglaub
- Department of Plastic and Hand Surgery, University Erlangen, Germany.
| | | | | | | | | | | | | |
Collapse
|
42
|
Unglaub F, Thomas SB, Kroeber MW, Dragu A, Fellenberg J, Wolf MB, Horch RE. Apoptotic pathways in degenerative disk lesions in the wrist. Arthroscopy 2009; 25:1380-6. [PMID: 19962063 DOI: 10.1016/j.arthro.2009.04.071] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Revised: 04/10/2009] [Accepted: 04/17/2009] [Indexed: 02/02/2023]
Abstract
PURPOSE Degenerative articular disk perforations of the triangular fibrocartilage (TFC) of the wrist could result from chronic loading of the ulnocarpal joint. Apoptosis played a crucial role in fibrocartilage cell loss, and the purpose of this study was to clarify which apoptotic pathway was involved in the development of degenerative disk lesions. We also investigated whether ulna length played an etiologic role in the occurrence of fibrocartilage cell loss. METHODS Included in the study were 17 patients with degenerative articular disk tears of the TFC (Palmer type 2C). After arthroscopic debridement of the TFC, histologic sections were examined to assess the presence of apoptosis. Apoptosis was determined by use of caspase 3, caspase 8, and caspase 9 immunohistochemistry. Furthermore, Fas ligand and BID (BH3 interacting domain death) agonist were applied for immunohistochemical analysis. RESULTS Cells positive for caspase 3, caspase 8, caspase 9, Fas ligand, and BID were found in all specimens. The number of cells positive for caspase 3 and BID was significantly increased in specimens from patients with an ulna-positive variance. In contrast, for cells positive for caspase 8, caspase 9, and Fas ligand, no significant difference was found between specimens from patients with an ulna-positive variance and those from patients with an ulna-neutral/ulna-negative variance. CONCLUSIONS The extrinsic and intrinsic apoptotic pathways are involved in the development of degenerative disk lesions. Fibrocartilage cell loss occurs mainly through the intrinsic apoptotic pathway. The accumulation of apoptotic cells is not significantly different between the 3 zones of the TFC. It could be verified that ulna length is correlated with fibrocartilage cell loss. CLINICAL RELEVANCE Ulnar shortening is a valuable treatment option for degenerative TFC lesions. Knowledge of the specific apoptotic pathway that is causing degenerative disk lesions is critical in selecting the appropriate and most beneficial therapeutic treatment to halt further cell loss and the degeneration of the TFC.
Collapse
Affiliation(s)
- Frank Unglaub
- Department of Plastic and Hand Surgery, University of Erlangen, Erlangen, Germany.
| | | | | | | | | | | | | |
Collapse
|
43
|
Lubowitz JH, Poehling GG. Keeping up with the literature: knee ligament, wrist triangular fibrocartilage tear, and suture bridge rotator cuff technique questions. Arthroscopy 2008; 24:1203-4. [PMID: 18971048 DOI: 10.1016/j.arthro.2008.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Accepted: 09/05/2008] [Indexed: 02/02/2023]
|