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Shinohara I, Inui A, Mifune Y, Yamaura K, Mukohara S, Kuroda R. Foveal Triangular Fibrocartilage Complex Tear Repair With Nonabsorbent Suture Tape. J Hand Surg Am 2024; 49:709.e1-709.e8. [PMID: 36841664 DOI: 10.1016/j.jhsa.2022.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 02/27/2023]
Abstract
PURPOSE Arthroscopic repair is performed for fovea injuries of the triangular fibrocartilage complex (TFCC) when instability of the distal radioulnar joint results in pain, decreased grip strength, and mechanical symptoms. During TFCC repair, reconstruction of its attachment to the fovea is important. Nonabsorbent suture tapes have gained attention for ligament repair in the trapeziometacarpal joint, scapholunate ligament, and thumb metacarpophalangeal ligament. However, there are no reports of TFCC repair using suture tapes. We evaluated the early postoperative results of this approach. METHODS Participants underwent arthroscopic suture tape repair of foveal TFCC tears and were observed for more than 1 year. All repairs were performed using suture tapes and an outside-in technique with a bone tunnel from the ulnar shaft to the fovea. The postoperative complications, postoperative wrist range of motion, grip strength, and the Modified Mayo Score were evaluated. RESULTS Arthroscopic repair with a suture tape was performed for 20 hands using the outside-in technique. The ranges of motion for the operated and nonoperated hands were comparable 1 year after surgery (pronation, 84° ± 4°; supination, 83° ± 4°). The mean grip strength improved from 65% ± 13% before surgery to 89% ± 9% after a year. The mean Modified Mayo Score improved from 58 ± 11 before surgery to 91 ± 8 after a year. Postoperative complications included abnormal sensation of the dorsal ulnar side in 2 hands. CONCLUSIONS After using a suture tape to attach the TFCC to the fovea, satisfactory function was achieved in the early postoperative period with grip strength restoration. For the repair of foveal TFCC tears, attachment to the ulnar fovea is important, and repair by a suture tape may be useful. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Issei Shinohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsuyuki Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Kohei Yamaura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shintaro Mukohara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Mak MCK, Ho PC. Complications after arthroscopic triangular fibrocartilage complex (TFCC) surgery. J Hand Surg Eur Vol 2024; 49:149-157. [PMID: 38315134 DOI: 10.1177/17531934231218608] [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] [Indexed: 02/07/2024]
Abstract
Wrist arthroscopy is a valuable and widely utilized tool in the treatment of triangular fibrocartilage complex (TFCC) injuries. These procedures include synovectomy alone, peri-capsular or transosseous repair, and arthroscopic-assisted reconstruction, and each are associated with specific complications. This review describes the types of complications and their rates in different types of arthroscopic TFCC surgery reported in the literature and in our centre. Across the spectrum of arthroscopic TFCC surgery, complication rates and the learning curve increase with surgical complexity. Relevant anatomy, prevention and management of complications including nerve injury and irritation, extensor tendon injury and tendinitis, fracture, stiffness, and persistence of symptoms or instability are discussed. Vigilance to anatomical details and careful dissection can help to reduce complications that may result in disturbing pain and functional loss.
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Affiliation(s)
- Michael Chu Kay Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Pak Cheong Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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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.
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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.
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Jin J, Liang K, Wang L, Ye P, Wang J, Shi H. Advances in the Repair of Palmer type IB TFCC Injuries With Wrist Arthroscopy. Sports Med Arthrosc Rev 2023; 31:49-59. [PMID: 37418174 DOI: 10.1097/jsa.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
The triangular fibrocartilage complex (TFCC) is essential for maintaining wrist stability. Injury-caused pain is the primary cause of ulnar wrist pain. The TFCC injury refractory to conservative treatment requires further surgical treatment, and because Palmer type IB tears belong to peripheral injuries due to their proximity to the blood supply area, arthroscopic suture repair has become the preferred surgical method for TFCC injury repair, exhibiting strong healing ability. This study reviewed the anatomy of TFCC, injury classification, and advances in arthroscopic suturing for treating Palmer type IB.
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Affiliation(s)
- Jianmiao Jin
- Department of hand and foot surgery, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University, Shaoxing, China
| | - Kejiong Liang
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Luo Wang
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Po Ye
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jinzhong Wang
- Department of hand and foot surgery, Shaoxing Hospital of Traditional Chinese Medicine, Shaoxing TCM Hospital Affiliated to Zhejiang Chinese Medical University, Shaoxing, China
| | - Haifei Shi
- Department of Orthopedics, First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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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.
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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
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Relevant landmarks to navigate the suture locations for the arthroscopic triangular fibrocartilage complex foveal reattachment. Arch Orthop Trauma Surg 2023; 143:1707-1714. [PMID: 36087140 DOI: 10.1007/s00402-022-04600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/20/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Key step of arthroscopic triangular fibrocartilage complex (TFCC) foveal reattachment is to suture dorsal and palmar deep components of radioulnar ligaments (RULs) to the fovea of ulnar head to ensure distal radioulnar joint stability. However, the deep components are covered and cannot be identified arthroscopically from standard radiocarpal joint view. Suturing sites described in previous studies have not been proved gasping of the deep components. The purpose of this study was to investigate our TFCC suture locations using relevant landmarks on securing the RULs' deep components for arthroscopic TFCC foveal reattachment. MATERIALS AND METHODS Wrist arthroscopy and horizontal mattress suture was performed in 20 fresh-frozen cadaver wrists. Based on close proximity of the ulnocarpal ligaments to the palmar RUL and fovea, palmar suture location was designated at the junction between ulnolunate, ulnotriquetral ligaments and palmar border of TFCC disc, whereas dorsal suture location was at dorsal border of TFCC disc, opposite the palmar location, at same distance between prestyloid recess and palmar location. The radiocarpal and ulnocarpal joint was subsequently opened to evaluate grasping of RULs' deep components and evaluate the relevant landmarks. RESULTS Thirty-nine of 40 (97%) RULs' deep components were successfully grasped by the sutures. With 0.98-0.99 interobserver agreement for the measurements, mean distance between sigmoid notch to suture and suture to ulnar capsule were 5.6 ± 1.1 and 4.0 ± 0.9 mm, respectively. Whereas, the dissecting point of deep component from the superficial component of the RULs was detected immediately radial to the midpoint between the sigmoid notch and the ulnar capsule (4.5 ± 0.9 mm from sigmoid notch). CONCLUSIONS We determined the relevant anatomical landmarks to navigate the TFCC suture locations, which reliably secure the deep components of the radioulnar ligaments for the arthroscopic TFCC foveal reattachment.
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Ryoo HJ, Kim YB, Kwak D, Choi IC, Park JW. Ulnar positive variance associated with TFCC foveal tear. Skeletal Radiol 2023:10.1007/s00256-023-04280-0. [PMID: 36752828 DOI: 10.1007/s00256-023-04280-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The ulnar positive variance (UPV) can be observed on simple radiography due to a triangular fibrocartilage complex (TFCC) foveal tear. This study investigated to identify how much radiographic UPV occurs due to a TFCC foveal tear, which may be misdiagnosed as an ulnar impaction syndrome (UIS). MATERIALS AND METHODS One hundred forty patients who underwent arthroscopic transosseus TFCC foveal repair from March 2013 to March 2019 in our institution were enrolled in this study. Ulnar variances were measured in preoperative, postoperative 6 weeks, 1-year follow-up wrist posteroanterior (PA) radiograph, and power grip PA radiograph of the affected wrist and were compared with those of the same patient's unaffected wrist. RESULTS In the neutral wrist PA radiograph, ulnar variance increased by 0.56 mm (p < 0.001) after TFCC foveal tear compared to the unaffected side. In the power grip view, ulnar variance also increased by 0.39 mm (p < 0.001) in the affected wrist. The preoperative ulnar positive variance was reduced after an arthroscopic transosseous TFCC foveal repair from 0.56 to 0 mm (p < 0.001). No significant statistical difference was observed between an Atzei class 2 and 3 TFCC tear (0.56 mm vs. 0.41 mm, p = 0.263). CONCLUSION This study revealed that TFCC foveal tear induces 0.56 mm of radiologic UPV, which was successfully corrected after arthroscopic transosseous TFCC foveal repair. Therefore, UPV associated with TFCC foveal tear should not be misdiagnosed as an UIS. Also, when ulnar shortening osteotomy is planned in case of UIS combined with TFCC foveal tear, the amount of UPV induced by TFCC foveal tear should be considered to prevent over-shortening.
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Affiliation(s)
- Hyun Jae Ryoo
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Yong Bin Kim
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Donghee Kwak
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, College of Medicine, Korea University, Seoul, Korea.
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Clinical Outcomes of Arthroscopic One-Tunnel Triangular Fibrocartilage Complex Transosseous Suture Repair Are Not Diminished in Cases of Ulnar Styloid Process Fracture Nonunion. Arthroscopy 2023; 39:32-38. [PMID: 35995332 DOI: 10.1016/j.arthro.2022.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/24/2022] [Accepted: 07/28/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether clinical outcomes of arthroscopic one-tunnel wrist triangular fibrocartilage complex (TFCC) transosseous suture repair are not diminished in cases of ulnar styloid process fracture nonunion (USPFN). METHODS Patients who underwent arthroscopic 1-tunnel transosseous suture repair of Palmer 1B foveal TFCC tear (with/without superficial fiber tear; Atzei class 2 or 3 TFCC tear) from 2015 to 2020 were retrospectively reviewed. Group I was the TFCC foveal tear repair group with USPFN. Group II was the TFCC foveal tear repair group without USPFN. In group I, no additional treatment for USPFN was made. Functional preoperative and postoperative outcomes were compared by Modified Mayo Wrist Score (MMWS); Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score; grip strength; pain visual analog scale (VAS); and distal radioulnar joint (DRUJ) stability. Wrist posteroanterior, lateral, and both oblique views of the wrist were used to assess the ulnar styloid process before and after operation. RESULTS This study consisted of 66 patients: group I (n = 22) and group II (n = 44). No differences were found between the 2 groups preoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P = .94, Quick-DASH: P = .23, grip strength: P = .69, VAS: P = .45). No differences were found between the 2 groups with respect to outcome measures postoperatively in MMWS, Quick-DASH, grip strength, and VAS (MMWS: P = .59, Quick DASH: P = .82, grip strength: P = .15, VAS: P = .84). All of the enrolled patients achieved restored function with negative ballottement test and maintained DRUJ stability on follow-up. Of the 22 USPFN cases in group I, 11 (50%) showed spontaneous union after transosseous TFCC foveal repair without any additional USPFN treatment. The proportion of patients achieving a minimal clinically important difference for the Quick-DASH was similar between the 2 groups. CONCLUSIONS Although this current study has insufficient statistical power, the available data suggest that patients with TFCC foveal tear combined with USPFNs treated with arthroscopic transosseous repair surgery could experience similar functional improvement compared with those with TFCC foveal tear without USPFNs. The presence of USPFN accompanied by Palmer 1B type TFCC foveal tear may not affect the clinical results, including MMWS, Quick-DASH, grip strength, VAS, and DRUJ stability of patients who undergo arthroscopic 1-tunnel transosseous suture repair. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Azócar C, Corvalán G, Cobb P, Román J, Orellana P. Lesiones traumáticas crónicas del complejo fibrocartílago triangular: ¿Cómo enfrentarlas? REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2022. [DOI: 10.1055/s-0042-1758190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
ResumenLas lesiones crónicas del complejo fibrocartílago triangular (CFCT) son una entidad que no ha sido descrita previamente como tal y no existe consenso en su manejo. La temporalidad de la lesión y su potencial de reparación son aspectos fundamentales a la hora de indicar un tratamiento. Proponemos un esquema de enfrentamiento a lesiones traumáticas crónicas del CFCT y describimos una técnica novedosa de reconstrucción con injerto de brachioradialis con asistencia artroscópica. Mostramos los resultados y el seguimiento de dos pacientes intervenidos con esta técnica.
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Affiliation(s)
- Camila Azócar
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Gonzalo Corvalán
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Peter Cobb
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Javier Román
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
| | - Pablo Orellana
- Equipo de Mano y Microcirugía, Servicio de Traumatología y Ortopedia, Clínica Indisa, Santiago, Chile
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Yeh CW, Hsu CE, Ho TY, Wei BH, Wang WC, Chiu YC. Midterm Results of Arthroscopy-Assisted "Tent Form" Triangular Fibrocartilage Complex Repair With Dorsal Distal Radioulnar Joint Capsule Imbrication for Posttraumatic Chronic Distal Radioulnar Joint Instability. Arthroscopy 2022; 38:1846-1856. [PMID: 35042008 DOI: 10.1016/j.arthro.2022.01.009] [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: 08/11/2021] [Revised: 01/01/2022] [Accepted: 01/06/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the outcomes of "tent form" triangular fibrocartilage complex (TFCC) repair combined with dorsal distal radioulnar joint (DRUJ) capsule imbrication for posttraumatic chronic DRUJ instability. METHODS All patients treated with arthroscopic "tent form" TFCC repair and DRUJ capsule imbrication from 2016 to 2019 were retrospectively reviewed. The inclusion criteria were symptomatic chronic DRUJ instability for >6 months and dorsal DRUJ subluxation on magnetic resonance imaging. The Disabilities of the Arm, Shoulder, and Hand score, Patient-Rated Wrist Evaluation, grip strength, Modified Mayo Wrist Score, range of motion, and distal radioulnar joint stability were assessed for a minimum of 2 years postoperatively. RESULTS Thirty-eight patients were included in the final analysis. The average follow-up duration was 35.6 months (range, 24-48 months). The 24-month postoperative grip strengths and 3-dimensional motions of wrist were not significantly different from that of the nonoperated wrist. Compared with their preoperative status, Disabilities of the Arm, Shoulder, and Hand score, Patient-Rated Wrist Evaluation, and Modified Mayo Wrist Score indicated the significant improvement with P values of .001, .001, and .002, respectively. CONCLUSIONS In chronic DRUJ instability with a loosening dorsal capsule, "tent form" TFCC transcapsular repair combined with DRUJ capsule imbrication restored the integrity of TFCC and dorsal DRUJ capsule and achieved a promising outcome. We recommend this procedure as an option of treatment for patients with posttraumatic chronic DRUJ instability. LEVEL OF EVIDENCE IV, case series.
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Affiliation(s)
- Chen-Wei Yeh
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Cheng-En Hsu
- Sports Recreation and Health Management Degree Program, Tunghai University, Taichung, Taiwan; Department of Orthopedics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsung-Yu Ho
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Bor-Han Wei
- Department of Orthopedics, China Medical University Beigang Hospital, Yunlin, Taiwan
| | - Wei-Chih Wang
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Orthopedic Surgery, China Medical University Hospital, Taichung, Taiwan.
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Jung HS, Park JG, Park HJ, Lee JS. Postoperative immobilization using a short-arm cast in the semisupination position is appropriate after arthroscopic triangular fibrocartilage complex foveal repair. Bone Joint J 2022; 104-B:249-256. [PMID: 35094578 DOI: 10.1302/0301-620x.104b2.bjj-2021-0592.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to assess and compare active rotation of the forearm in normal subjects after the application of a short-arm cast (SAC) in the semisupination position and a long-arm cast (LAC) in the neutral position. A clinical study was also conducted to compare the functional outcomes of using a SAC in the semisupination position with those of using a LAC in the neutral position in patients who underwent arthroscopic triangular fibrocartilage complex (TFCC) foveal repair. METHODS A total of 40 healthy right-handed volunteers were recruited. Active pronation and supination of the forearm were measured in each subject using a goniometer. In the retrospective clinical study, 40 patients who underwent arthroscopic foveal repair were included. The wrist was immobilized postoperatively using a SAC in the semisupination position (approximately 45°) in 16 patients and a LAC in 24. Clinical outcomes were assessed using grip strength and patient-reported outcomes. The degree of disability caused by cast immobilization was also evaluated when the cast was removed. RESULTS Supination was significantly more restricted with LACs than with SACs in the semisupination position in male and female patients (p < 0.001 for both). However, pronation was significantly more restricted with SACs in the semisupination position than with LACs in female patients (p = 0.003) and was not significantly different in male patients (p = 0.090). In the clinical study, both groups showed improvement in all parameters with significant differences in grip strength, visual analogue scale scores for pain, modified Mayo Wrist Score, the Disability of the Arm, Shoulder, and Hand (DASH) score, and the Patient-Rated Wrist Evaluation (PRWE) score. No significant postoperative differences were noted between LACs and SACs in the semisupination position. However, the disability caused by immobilization in a cast was significantly higher in patients who had a LAC on the dominant hand (p < 0.001). CONCLUSION We found that a SAC in the semisupination position is as effective as a LAC in restricting pronation of the forearm. In addition, postoperative immobilization with a SAC in the semisupination position resulted in comparable pain scores and functional outcomes to immobilization with a LAC after TFCC foveal repair, with less restriction of daily activities. Therefore, we recommend that surgeons consider using a SAC in the semisupination position for postoperative immobilization following TFCC foveal repair for dorsal instability of the distal radioulnar joint. Cite this article: Bone Joint J 2022;104-B(2):249-256.
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Affiliation(s)
- Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, South Korea
| | - Jung-Gwan Park
- Department of Orthopaedic Surgery, Madisesang Hospital, Seoul, South Korea
| | - Hyeong-Jun Park
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, South Korea
| | - Jae Sung Lee
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, South Korea
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Lee SH, Gong HS. Grip Strength Measurement for Outcome Assessment in Common Hand Surgeries. Clin Orthop Surg 2022; 14:1-12. [PMID: 35251535 PMCID: PMC8858903 DOI: 10.4055/cios21090] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 11/25/2022] Open
Abstract
Grip strength has been used to evaluate the upper extremity functional status and clinical outcomes following upper extremity trauma or surgery. Understanding general recovery patterns of grip strengthening can be helpful in assessing the patients’ recovery status and in assisting in preoperative consultations regarding expectations for recovery. We summarize related studies on grip strength measurement and recovery patterns in common hand conditions, including carpal tunnel syndrome, cubital tunnel syndrome, triangular fibrocartilage complex injury, and distal radius fractures.
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Affiliation(s)
- Seung Hoo Lee
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Lu C, Zhang H, Zhang L, Wang P, Wang X. [Anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex injury under wrist arthroscopy]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1417-1421. [PMID: 34779167 DOI: 10.7507/1002-1892.202104126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of anatomical repair of Atzei-EWAS type 2 triangular fibrocartilage complex (TFCC) injury under wrist arthroscopy. Methods Between March 2018 and March 2020, 16 patients with Atzei-EWAS type 2 TFCC injury were admitted, and the TFCCs were anatomically repaired with a three-dimensional suture with a thread anchor under wrist arthroscopy. There were 10 males and 6 females with an average of 40.2 years (range, 22-54 years). The disease duration ranged from 2 to 9 months (mean, 6.4 months). Preoperative grip strength of the affected limb was (20.06±3.38) kg, wrist range of motion in flexion and extension was (117.19±7.74)°, radial-ulnar deviation was (31.25±5.32)°, forearm rotation range of motion was (137.19±14.83)°, visual analogue scale (VAS) score was 5.6±1.2. At last follow-up, the effectiveness was evaluated by the grip strength of the affected limb, the range of motion of the wrist joint, the VAS score, and the modified Mayo wrist score. Results All incisions healed by first intention. One case had paralysis of the dorsal branch of the ulnar nerve after operation, and no other complications occurred in other cases. All patients were followed up 12-18 months (mean, 14.5 months). The distal radioulnar joint stability of all patients recovered. At last follow-up, the grip strength of the affected limb was (24.88±3.26) kg, the range of motion in flexion and extension was (146.59±6.49)°, radial-ulnar deviation was (39.38±6.55)°, and forearm rotation range of motion was (152.50±11.55)°, which were significantly higher than those before operation ( P<0.05); the VAS score was 0.9±0.8, which was significantly lower than that before operation ( t=21.029, P=0.000). The modified Mayo wrist score was rated as excellent in 10 cases, good in 5 cases, and fair in 1 case. The excellent and good rate was 93.8%. MRI results showed that TFCC healed in all cases. Conclusion For Atzei-EWAS type 2 TFCC injury, anatomical repair under wrist arthroscopy can restore the anatomical structure of TFCC, effectively relieve wrist pain, improve function, and obtain good effectiveness.
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Affiliation(s)
- Chengyin Lu
- Luoyang Pingle Bone Setting College, Henan University of Chinese Medicine, Luoyang Henan, 471002, P.R.China
| | - Hailong Zhang
- The 2nd Department of Sports Medicine and Arthroscopy, Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital), Luoyang Henan, 471002, P.R.China
| | - Laifu Zhang
- Luoyang Pingle Bone Setting College, Henan University of Chinese Medicine, Luoyang Henan, 471002, P.R.China
| | - Pengtao Wang
- Luoyang Pingle Bone Setting College, Henan University of Chinese Medicine, Luoyang Henan, 471002, P.R.China
| | - Xiaohui Wang
- Luoyang Pingle Bone Setting College, Henan University of Chinese Medicine, Luoyang Henan, 471002, P.R.China
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Xu T, Pan X, Mi J. Improved Outside-In Suture through the Joint Capsule to Repair the Palmer I-B Triangular Fibrocartilage Complex Superficial Injury. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:8387813. [PMID: 34804195 PMCID: PMC8598346 DOI: 10.1155/2021/8387813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/13/2021] [Accepted: 10/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The treatment of type I-B triangular fibrocartilage complex superficial injury is always a challenge to orthopedists. The traditional outside-in suture method often causes a risk of nervous irritation. We designed a modified outside-in suture through the joint capsule to repair the Palmer I-B triangular fibrocartilage complex superficial injury. METHODS From December 2014 to December 2018, we retrospectively collected the medical records of 18 patients in our hospital who used the modified outside-in suture through the joint capsule to repair type I-B triangular fibrocartilage complex superficial injury. Among them, there were 12 males and 6 females, with an average age of 36.2 years. There were 6 cases on the left side and 12 cases on the right side. Record the healing time of all patients after surgery and the occurrence of related complications, and record the pain visual analogue scale (VAS), grip strength, wrist flexion and extension, radioulnar deviation and forearm rotation range of motion, modified Mayo wrist joint function score, and disability of arm-shoulder-hand (DASH) score before operation and at the last follow-up. RESULTS One patient was lost to follow-up, and a total of 17 patients received the final follow-up. Patients were followed up for 24 to 36 months, with an average of 29.6 ± 3.0 months. No wound infection, nerve damage, or irritation occurred after the operation. At the last follow-up, 15 cases of wrist pain disappeared completely, and 2 cases had mild discomfort during exercise. At the last follow-up, VAS decreased from 3.8 ± 0.7 points before operation to 0.8 ± 0.7 points (P < 0.05); grip strength increased from 15.1 ± 3.1 kg before operation to 23.2 ± 1.5 kg (P < 0.05); wrist flexion and extension, radioulnar deflection, and forearm rotational mobility increased from 116.3 ± 2.2°, 37.0 ± 3.5°, and 141.6 ± 2.2° before operation to 117.2 ± 2.5° (P < 0.05), 38.9 ± 3.0° (P < 0.05), and 142.4 ± 1.9° (P < 0.05), respectively; the modified Mayo wrist joint function score increased from 66.1 ± 3.6 points to 82.5 ± 3.9 points (P < 0.05), of which 10 cases were excellent, 5 cases were good, 2 cases were fair, and the excellent and good rate was 88.2%; DASH score improved from 37.0 ± 5.7 points preoperatively to 8.0 ± 2.5 points (P < 0.05). CONCLUSION The modified outside-in suture through the joint capsule to repair the superficial injury of Palmer I-B triangular fibrocartilage complex has a good clinical effect and is worthy of clinical widespread promotion.
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Affiliation(s)
- Tonglong Xu
- Medical College, Soochow University, Suzhou, China
- Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Xiaoyun Pan
- Medical College, Soochow University, Suzhou, China
- Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
| | - Jingyi Mi
- Medical College, Soochow University, Suzhou, China
- Wuxi 9th People's Hospital Affiliated to Soochow University, Liangxi Road, No.999, Binhu District, Wuxi, Jiangsu, China
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Hearon BF, Frantz LM, Helsper EA, Morris HA. Experience with Diagnosis and Management of Distal Radioulnar Joint Instability. J Wrist Surg 2021; 10:392-400. [PMID: 34631291 PMCID: PMC8489992 DOI: 10.1055/s-0041-1726408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/08/2021] [Indexed: 10/21/2022]
Abstract
Objective The aim of this study is to review our cumulative experience with diagnosis and treatment of distal radioulnar joint (DRUJ) instability and to present our treatment algorithm. Materials and Methods Retrospective review identified 112 patients who had 126 episodes of care for DRUJ instability at a single institution over a 21-year period. Those diagnosed acutely or subacutely were treated with immobilization of the wrist and elbow for 6 weeks, while those with chronic instability had anatomic reconstruction of the dorsal and palmar radioulnar ligaments with tendon autograft or an alternative arthroscopic treatment with our thermal annealing technique. Short-term treatment failures and surgical complications were recorded. Nonparametric statistical tests were used to analyze key long-term outcome measures including ulnar wrist pain and DRUJ stability indicated by the dorsopalmar stress test. Results At mean 7-year follow-up, eight patients in the acute-injury cohort had statistically significant improvements in wrist pain and DRUJ instability ( p < 0.001). In both the 22-patient anatomic reconstruction cohort and the 37-patient arthroscopically treated group, there were also statistically significant improvements in wrist pain and DRUJ stability ( p < 0.001) at mean 9-year follow-up. The majority of patients in all three groups was satisfied with treatment outcome, though some required secondary procedures. Conclusion Early clinical diagnosis of DRUJ instability using the dorsopalmar stress test provides an opportunity for effective nonsurgical treatment. For chronic presentation, we recommend our arthroscopic thermal annealing technique for mild or moderate instability and open anatomic reconstruction of the radioulnar ligaments for severe instability. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Bernard F. Hearon
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
- Advanced Orthopaedic Associates, Wichita, Kansas
| | - Lisa M. Frantz
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
| | - Elizabeth A. Helsper
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
| | - Harry A. Morris
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas
- Advanced Orthopaedic Associates, Wichita, Kansas
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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.
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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.
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Abe Y. Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage. Arthroscopy 2021; 37:1651-1653. [PMID: 33485941 DOI: 10.1016/j.arthro.2021.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/02/2021] [Accepted: 01/14/2021] [Indexed: 02/02/2023]
Abstract
The ulnar head attachment of triangular fibrocartilage complex is divided into 2 sections: the distal radioulnar ligament consists of superficial and deep bundles on both the palmar and dorsal sides, which attach at the fovea and the base of the ulnar styloid. A tear on the ulnar side of triangular fibrocartilage complex inevitably occurs at these attachments. Both magnetic resonance imaging and distal radioulnar joint (DRUJ) arthroscopy are crucial. DRUJ arthroscopy can clarify the tear location. An ulnar styloid tear can be treated by capsular repair. However, a foveal tear should be reattached to the fovea because this tear could cause gross DRUJ instability. There are several ways to reattach the bundles to the fovea, including single- or double-tunnel or bone anchors, and open versus arthroscopic.
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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.
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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
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Waitayawinyu T. Arthroscopic-Assisted Inside-Out Foveal Reattachment of Triangular Fibrocartilage Complex. Arthrosc Tech 2021; 10:e1333-e1338. [PMID: 34141550 PMCID: PMC8185890 DOI: 10.1016/j.eats.2021.01.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/31/2021] [Indexed: 02/03/2023] Open
Abstract
The dorsal and palmar radioulnar ligaments are the deep components of the triangular fibrocartilage complex (TFCC), which provides stability to the distal radioulnar joint (DRUJ). In patients with DRUJ instability, arthroscopic procedures are currently focused on reattachment of the deep components of the TFCC to the fovea of the ulnar head. TFCC-foveal reattachment can be performed either by using the transosseous technique with creation of a bone tunnel or by suturing to a bone anchor. Most previous studies of the TFCC suture method have used an outside-in technique. We herein present an arthroscopic inside-out TFCC-foveal reattachment technique with a bony anchor for the treatment of DRUJ instability. This technique has novel advantages, including less exposure, less soft-tissue dissection, and greater ease of TFCC suturing. This procedure may thus be considered another good option for the treatment of TFCC injury with DRUJ instability.
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Affiliation(s)
- Thanapong Waitayawinyu
- Address correspondence to Thanapong Waitayawinyu, M.D., Department of Orthopaedics, Faculty of Medicine, Thammasat University, 99/209 Paholyothin Rd., Klong Luang, Pathumthani, 12120, Thailand.
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Abe Y. Editorial Commentary: Triangular Fibrocartilage Complex "Fovea"-An Attractive and Complicated Structure-Is "The Anchor" Not Only for Distal Radioulnar Joint but Also for Wrist Surgeons. Arthroscopy 2020; 36:1853-1855. [PMID: 32624121 DOI: 10.1016/j.arthro.2020.04.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 02/02/2023]
Abstract
A triangular fibrocartilage complex foveal lesion is one of the key structures for stabilizing the distal radioulnar joint. Its anatomy is unique and healing potential is still controversial. If surgical repair is necessary, ulnar abutment is contraindicated, evaluation of the ligament condition using distal radioulnar joint arthroscopy is crucial to achieve satisfactory results.
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