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Choudhury MM, Yap RTJ, Jiang JKH, Chia DSY, Chin AYH. An All-Arthroscopic Technique of Repairing Foveal Tears of the Triangular Fibrocartilage Complex Using a Bone Anchor-Repair Made Simple. Tech Hand Up Extrem Surg 2024; 28:19-25. [PMID: 38380473 DOI: 10.1097/bth.0000000000000454] [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: 02/22/2024]
Abstract
Traumatic foveal tears of the triangular fibrocartilage complex lead to ulnar-sided wrist pain and instability, resulting in painful motion and loss of grip strength with a severe impact on the overall function of the upper limb. Surgical repair is nothing new and has traversed through the realm of open repair to arthroscopic assisted to all arthroscopic repair techniques over the many decades, with arthroscopic repairs showing better visualization, lesser trauma, and equally favorable patient outcomes. Techniques had varied from using trans osseous tunnels to bone anchors, with or without the usage of special jigs. Here, we describe a simple and fast 3 portal arthroscopic technique of repairing the torn foveal insertion of the triangular fibrocartilage complex using a bone anchor inserted under arthroscopic and fluoroscopic guidance into the fovea. Both the dorsal and volar limbs of the triangular fibrocartilage complex are repaired arthroscopically, resulting in a strong anatomic repair resulting in a stable and pain-free wrist.
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Affiliation(s)
- Muntasir Mannan Choudhury
- Department of Orthopaedic Surgery, Sengkang General Hospital
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
| | - Robert Tze Jin Yap
- Department of Orthopaedic Surgery, Sengkang General Hospital
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
| | - Jackson Kian Hong Jiang
- Department of Orthopaedic Surgery, Sengkang General Hospital
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
| | - Dawn Sinn Yii Chia
- Department of Orthopaedic Surgery, Sengkang General Hospital
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
| | - Andrew Yuan Hui Chin
- Department of Orthopaedic Surgery, Sengkang General Hospital
- Department of Hand and Reconstructive Microsurgery, Singapore General Hospital
- SingHealth Duke-NUS Musculoskeletal Sciences ACP, Singapore
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Liu EH, Suen K, Tham SK, Ek ET. Surgical Repair of Triangular Fibrocartilage Complex Tears: A Systematic Review. J Wrist Surg 2021; 10:70-83. [PMID: 33552699 PMCID: PMC7850810 DOI: 10.1055/s-0040-1718913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
Objective This study systematically reviews the outcomes of surgical repair of triangular fibrocartilage complex (TFCC) tears. Existing surgical techniques include capsular sutures, suture anchors, and transosseous sutures. However, there is still no consensus as to which is the most reliable method for ulnar-sided peripheral and foveal TFCC tears. Methods A systematic review of MEDLINE and EMBASE was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The focus was on traumatic Palmer 1B ulna-sided tears. Twenty-seven studies were included, including three comparative cohort studies. Results There was improvement in all functional outcome measures after repair of TFCC tears. The outcomes following peripheral and foveal repairs were good overall: Mayo Modified Wrist Evaluation (MMWE) score of 80.1 and 85.1, Disabilities of the Arm, Shoulder and Hand (DASH) score of 15.7 and 15.8, grip strength of 80.3 and 92.7% (of the nonoperated hand), and pain intensity score of 2.1 and 1.7, respectively. For peripheral tears, transosseous suture technique achieved better outcomes compared with capsular sutures in terms of grip strength, pain, Patient-Rated Wrist Evaluation (PRWE), and DASH scores (grip 85.8 vs. 77.7%; pain 1.5 vs. 2.2; PRWE 11.6 vs. 15.8; DASH 14.4 vs. 16.1). For foveal tears, transosseous sutures achieved overall better functional outcomes compared with suture anchors (MMWE 85.4 vs. 84.9, DASH 10.9 vs. 20.6, pain score 1.3 vs. 2.1), but did report slightly lower grip strength than the group with suture anchors (90.2 vs. 96.2%). Arthroscopic techniques achieved overall better outcomes compared with open repair technique. Conclusion Current evidence demonstrates that TFCC repair achieves good clinical outcomes, with low complication rates. Level of Evidence This is a Level IV, therapeutic study.
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Affiliation(s)
- Edward H. Liu
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Kary Suen
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
| | - Stephen K. Tham
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
- Victorian Hand Surgery Associates, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
| | - Eugene T. Ek
- Department of Orthopaedic Surgery, Division of Hand Surgery, Monash University, Dandenong Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Monash University, Monash Medical Centre, Melbourne, Victoria, Australia
- Hand and Wrist Biomechanics Laboratory (HWBL), O'Brien Institute/St. Vincent's Institute Fitzroy, Melbourne, Victoria, Australia
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia
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Cornu A, Amouyel T, Chantelot C, Saab M. Clinical, functional and prognostic results after repair of peripheral lesions of the triangular fibrocartilage complex: a retrospective study of 21 patients. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:557-562. [PMID: 33048247 DOI: 10.1007/s00590-020-02805-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 10/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The main objective of this study was to assess the clinical and functional outcomes of arthroscopic TFCC repair in patients with an isolated Atzei type 1, 2 or 3 lesion or after a distal radius fracture. The secondary objective was to identify which factors could contribute to poor functional outcome. METHODS A retrospective study was conducted from November 2017 to May 2019. The inclusion criteria were patients with an Atzei type 1, 2 or 3 TFCC lesion who underwent arthroscopic repair and with a minimum of 6-month follow-up. Wrist motion, grip and pronation-supination strength were noted. QuickDASH, MMWS and PRWE scores were performed. An analysis was conducted to search for poor outcomes predictive factors (MMWS < 80). RESULTS Twenty-one patients were included with a mean follow-up of 26 months. Seventeen patients (80%) had an Atzei 1 lesion, one (4.8%) had an Atzei 2, and 3 (14%) had an Atzei 3. Wrist motion significantly decreased compared to contralateral. Only pronation and supination were not significant. Grip strength was 73.4% compared to the contralateral (p = 0.002). Mean PRWE was 29.14 (1.5-70.5), QuickDASH was 30.72 (2.3-70.5), and MMWS was 79.3 (35-100). In all patients with a MMWS ≥ 80, none had lunotriquetral lesions when it was the case for 5 of 9 patients with a MMWS < 80 (p = 0.006). Except a story of workplace injury, no other prognosis factor was significant. CONCLUSION Patients with Atzei 1, 2 or 3 TFCC who underwent arthroscopic repair seem to have good outcomes. However, an associated lunotriquetral lesion appears to worsen the functional prognosis.
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Affiliation(s)
- Alexandre Cornu
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France. .,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France.
| | - Thomas Amouyel
- Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
| | - Christophe Chantelot
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France.,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
| | - Marc Saab
- Service de Traumatologie, CHRU Lille Salengro, Avenue professeur Emile Laine, 59037, Lille, France.,Service d'Orthopédie 1, CHRU Lille Salengro, Avenue du professeur Emile Laine, 59037, Lille, France
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