1
|
Yin Z, Zhou W, Ma J, Chen J, Zhou F. Arthroscopic dual-bone tunnel repair for palmer type IB injuries of the triangular fibrocartilage complex. BMC Musculoskelet Disord 2024; 25:671. [PMID: 39192239 DOI: 10.1186/s12891-024-07809-z] [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: 03/28/2024] [Accepted: 08/21/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND Triangular fibrocartilage complex (TFCC) injuries, especially Palmer type IB, pose surgical management challenges due to associated distal radial ulnar joint (DRUJ) instability. Traditional surgeries entail risks of complications. Arthroscopic repair presents advantages but lacks consensus on optimal techniques. To evaluate arthroscopic dual-bone tunnel repair in patients with Palmer type IB TFCC injuries of the wrist. METHODS In this retrospective case series, grip strength ratio, joint range of motion, pain visual analogue scale (VAS), modified Mayo wrist score, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were assessed before and 12 months after surgery. RESULTS The cohort consisted of 45 patients. At 12 months, the grip strength ratio improved from 0.71 ± 0.08 to 0.93 ± 0.05 (P < 0.001), and wrist joint rotation increased from 126.78 ± 13.28° to 145.76 ± 8.52° (P < 0.001). VAS (1.60 ± 0.58 vs. 6.33 ± 0.91, P < 0.001), DASH (12.96 ± 3.18 vs. 46.87 ± 6.62, P < 0.001), and modified Mayo wrist (88.11 ± 4.43 vs. 63.78 ± 7.99, P < 0.001) scores all improved after surgery. The overall complication rate was 4.44%. CONCLUSION Arthroscopic dual-bone tunnel repair appears to be an effective intervention for alleviating wrist pain, restoring stability, and enhancing joint function in patients with TFCC Palmer type IB injuries.
Collapse
Affiliation(s)
- Zhen Yin
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, No. 68, Gehu Middle Road, Wujin District, Changzhou, 213000, Jiangsu, China
| | - Weibo Zhou
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, No. 68, Gehu Middle Road, Wujin District, Changzhou, 213000, Jiangsu, China
| | - Jiayi Ma
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, No. 68, Gehu Middle Road, Wujin District, Changzhou, 213000, Jiangsu, China
| | - Jie Chen
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, No. 68, Gehu Middle Road, Wujin District, Changzhou, 213000, Jiangsu, China
| | - Fulin Zhou
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, No. 68, Gehu Middle Road, Wujin District, Changzhou, 213000, Jiangsu, China.
| |
Collapse
|
2
|
Yeh CW, Hsu CE, Ho TY, Wang WC, Lee AKX, Wei BH, Chiu YC. Effect of dorsal capsular imbrication on intraoperative DRUJ instability following arthroscopic TFCC repair surgery. BMC Musculoskelet Disord 2024; 25:543. [PMID: 39010002 PMCID: PMC11247898 DOI: 10.1186/s12891-024-07663-z] [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: 05/18/2024] [Accepted: 07/05/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND To assess the clinical outcomes and identify the ideal indication for implementing dorsal distal radioulnar joint (DRUJ) capsular imbrication after triangular fibrocartilage complex (TFCC) repair in cases of DRUJ instability. METHODS We conducted a retrospective study on patients who underwent arthroscopic TFCC repair between 2016 and 2021. Inclusion criteria comprised a symptomatic ulna fovea sign for over 6 months and dorsal DRUJ subluxation on magnetic resonance imaging. A total of 225 patients were divided into two groups: Group 1 (135 cases) with a negative ballottement test after "Cross-form TFCC repair" (CR) and Group 2 (90 cases) with a positive ballottement test after "Cross-form TFCC repair" and augmented DRUJ stability through dorsal DRUJ capsular imbrication (CR + DCI). Pain visual analog scale score (VAS), grip strength, modified Mayo Wrist Score (MMWS), wrist range of motion (ROM), and patient-reported outcomes (PROMs) were assessed for a minimum of 3 years postoperatively. RESULTS Both groups showed significant improvements in pain VAS score, grip strength, wrist ROM, MMWS, and PROMs between the preoperative and postoperative periods (all P < 0.05). Recurrent DRUJ instability occurred in 3.7% and 1.1% of patients in the "CR" and "CR + DCI" groups, respectively, with a significant difference. Despite the "CR + DCI" group initially exhibiting inferior ROM compared with the "CR" group, subsequently, no significant difference was noted between them. CONCLUSIONS Dorsal DRUJ capsular imbrication effectively reduces postoperative DRUJ instability rates, enhances grip strength, and maintains wrist ROM in patients with a positive intra-operative ballottement test after arthroscopic TFCC repair.
Collapse
Affiliation(s)
- Chen-Wei Yeh
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yude Rd., North Dist, Taichung, 404, Taiwan
| | - Cheng-En Hsu
- Sports Recreation and Health Management Degree Program, Tunghai University, Taichung, 407, Taiwan
- Department of Orthopedics, Taichung Veterans General Hospital, Taichung, 407, Taiwan
| | - Tsung-Yu Ho
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yude Rd., North Dist, Taichung, 404, Taiwan
| | - Wei-Chih Wang
- Department of Orthopedic Surgery, China Medical University Hsinchu Hospital, Hsinchu, 302, Taiwan
| | - Alvin Kai-Xing Lee
- School of Medicine, China Medical University, Taichung, 404, Taiwan
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yude Rd., North Dist, Taichung, 404, Taiwan
| | - Bor-Han Wei
- Cheng Ching Hospital Chung Kang Branch, Taichung, 407, Taiwan
| | - Yung-Cheng Chiu
- School of Medicine, China Medical University, Taichung, 404, Taiwan.
- Department of Orthopedic Surgery, China Medical University Hospital, No. 2, Yude Rd., North Dist, Taichung, 404, Taiwan.
| |
Collapse
|
3
|
Bezirgan U, Yoğun Y, Özgencil B, Dursun Savran M, Genç A, Armangil M. The Effect of Arthroscopic Triangular Fibrocartilage Repair on Accompanying Extensor Carpi Ulnaris Tendinitis and Synovitis in Triangular Fibrocartilage Tears. J Wrist Surg 2024; 13:241-247. [PMID: 38808190 PMCID: PMC11129892 DOI: 10.1055/s-0043-1775802] [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: 03/27/2023] [Accepted: 09/05/2023] [Indexed: 05/30/2024]
Abstract
Purpose Management of ulnar-sided wrist pain is difficult due to the complexity of the anatomy and the similarity of the signs and symptoms of possible diagnoses. The study's main purpose is to examine the effect of arthroscopic triangular fibrocartilage (TFC) repair on untreated extensor carpi ulnaris (ECU) tendinitis and synovitis. Methods Thirteen patients who underwent arthroscopic TFC repair in our clinic and preoperatively demonstrated ECU tendon pathology with magnetic resonance imaging (MRI) were included in the retrospective study. Pre- and postoperative visual analog scale (VAS), pre- and postoperative tendinitis and synovitis, postoperative Mayo and patient-rated wrist evaluation score, postoperative grip strength of the operated and control sides, short and long diameters of the ECU tendon in ultrasonography were recorded. Results The mean age of 13 patients (9 females and 4 males) was 39.54 ± 13.54, and the mean follow-up period was 26 ± 7.25 months. While there was no significant difference between pre- and postoperative tendinitis or synovitis levels, VAS decreased significantly (8.46 ± 1.33 vs. 3.00 ± 2.31, p = 0.0016). While the grip strength was 21.78 ± 7.83 on the control side, it was 18.28 ± 7.51 on the surgery side, being significantly lower ( p = 0.0252). Ulnar variance did not affect tendinitis or synovitis. Short and long diameters of ECU were similar for the operated and control sides. While the short diameter did not affect the synovitis-tendinitis score, the bigger the long diameter, the higher the synovitis score (rho = 0.5162). Conclusion In the presence of ECU, tendon pathologies accompanying TFC lesions, additional surgical interventions are mandatory as arthroscopic TFC repair has no significant effect on the healing of ECU. Level of evidence : 4.
Collapse
Affiliation(s)
- Uğur Bezirgan
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Yener Yoğun
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Bedir Özgencil
- Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Merve Dursun Savran
- Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| | - Aysun Genç
- Department of Physical Therapy and Rehabilitation, Ankara University Medical Faculty, Ankara, Turkey
| | - Mehmet Armangil
- Division of Hand and Upper Extremity Surgery, Department of Orthopedics and Traumatology, Ankara University Medical Faculty, Ankara, Turkey
| |
Collapse
|
4
|
Ravella KC, Yao J. Treatment of Hand and Wrist Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:104-112. [PMID: 38978204 DOI: 10.1097/jsa.0000000000000400] [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: 07/10/2024]
Abstract
Cartilage injuries of the hand and wrist can be debilitating in the athlete. Diagnosis is difficult given the broad spectrum of presenting symptomatology. History and physical examination is crucial to achieve the correct diagnosis, and advanced imaging can offer helpful assistance to the clinician as well. TFCC injuries and ulnar impaction syndrome are among the most common conditions in athletes with hand and wrist pain. Treatment of these injuries is initially nonoperative, but elite athletes may elect to bypass nonoperative treatment in favor of earlier return to sport. Surgical treatment varies but can include open and arthroscopic methods. The clinician should tailor treatment plans to each athlete based on level of competition, type of sport, and individual preferences and goals.
Collapse
Affiliation(s)
- Krishna C Ravella
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | | |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Simonsen S, Gvozdenovic R. A Modified Arthroscopic Ulnar Tunnel Technique for Combined Foveal and Capsular (All-Inside) Fixation of Triangular Fibrocartilage Complex Injury. J Wrist Surg 2024; 13:31-37. [PMID: 38264138 PMCID: PMC10803138 DOI: 10.1055/s-0043-1768237] [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: 07/23/2022] [Accepted: 03/06/2023] [Indexed: 01/25/2024]
Abstract
Background Traumatic disruption of the triangular fibrocartilage complex (TFCC) is commonly present in various wrist traumas. A variation of surgical techniques is previously developed for different injury patterns. To our knowledge, only a few studies have investigated the fixation of combined foveal and capsular TFCC injuries using the ulnar tunnel technique. Purpose This prospective cohort study of 21 patients aimed to evaluate the clinical and patient-reported outcome at 2 years of follow-up after arthroscopic TFCC of combined, foveal, and capsular reattachment by modified ulnar tunnel technique. Methods Pain, grip strength, wrist motion, inclusive rotation, and patient-reported outcomes were assessed pre- and postoperatively at 2 years of follow-up. Results No complications occurred preoperatively. Pain and patient-reported outcomes improved significantly ( p < 0.0001 and 0.004). Grip strength improved, but not significantly ( p = 0.088). The range of motion remained unchanged. All the patients achieved full stability of the distal radioulnar joint. Two patients sustained a new TFCC injury due to a wrist trauma and underwent a reoperation successfully. Two patients experienced complications: one patient experienced tenderness caused by cyst occurrence after PushLock ankers and the second had subluxation of the extensor carpi ulnaris tendon subsheet. Both patients were successfully treated and reoperated on with curettage of the cyst, and reconstruction of the extensor carpi ulnaris retinaculum. All the patients ended with good or excellent satisfaction scores. Conclusion The ulnar tunnel technique for combined foveal and capsular injuries shows promising short-term follow-up results and high satisfaction scores in the patients. Level of Evidence II (Prospective Corhorte).
Collapse
Affiliation(s)
- Sabine Simonsen
- Department of Hand Surgery, Herlev and Gentofte University Hospital of Copenhagen, Copenhagen, Denmark
| | - Robert Gvozdenovic
- Department of Hand Surgery, Herlev and Gentofte University Hospital of Copenhagen, Hellerup, Denmark
- University of Copenhagen, Faculty of Health and Medical Sciences, Institute of Clinical Medicine, Copenhagen N, Denmark
| |
Collapse
|
7
|
Khair Y, Mustafa A, Mestrihi S, Azzam E, Al-Qasaimeh M, Awad D, Ovidiu A. Outcome in TFCC repair using micro anchor and trans‑osseous technique. Exp Ther Med 2023; 26:557. [PMID: 37941586 PMCID: PMC10628646 DOI: 10.3892/etm.2023.12256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/15/2023] [Indexed: 11/10/2023] Open
Abstract
The triangular fibrocartilage complex (TFCC) is an intrinsic stabiliser of the distal radioulnar joint (DRUJ), which serves an important role in wrist movement, forearm rotation and grip strength. A stable DRUJ is a key requirement for pain-free movement of the wrist. TFCC tears are a common ulnar-sided wrist pain associated with decreased grip strength and impaired function. TFCC tears are classified according to the location and cause. The Palmer classification delineates tears into traumatic type 1 and degenerative type 2. The present study investigated the clinical outcomes of using micro suture anchors in open repair in comparison with trans-osseous TFCC repair. From July 2017 to July 2020, 51 patients underwent open repair of TFCC tear by hand and upper limb surgeons in Royal Rehabilitation Center at King Hussein Medical Center (Amman, Jordan). Stability of DRUJ and tenderness at the ulnar aspect of the wrist were evaluated by Disability of the Arm, Shoulder and Hand (DASH) and Modified Mayo Wrist Score (MMWS) pre- and post-operatively. A total of 38 patients (27 male and 11 females) underwent open repair using micro suture anchors and 13 (7 male and 6 female) by trans-osseous repair. A total of 51 patients in the follow-up 6-48 months had significant improvement in pain and range of motion. A total of 45 patients showed improved grip strength and were pain-free; six patients showed improvement of grip strength and decreased pain. For the patients who underwent TFCC repair by micro suture anchors, there was an improvement of MMWS from 70 to 90%, and for those who underwent TFCC repair by trans-osseous technique, MMWS improved from 65 to 85%. There was also significant improvement in DASH score post-operatively with both techniques, from 60 to 15% in the trans-osseous technique and from 70 to 15% in the suture anchors. Open repair of TFCC tears using either micro anchor or trans-osseous repair led to pain-free range of motion, improved grip strength, stable DRUJ and improvement in DASH and MMWS scores, with no significant differences in clinical outcome between techniques.
Collapse
Affiliation(s)
- Yousef Khair
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Ayman Mustafa
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Saab Mestrihi
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Ehab Azzam
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Motaz Al-Qasaimeh
- Department of Orthopaedics, Royal Medical Services, Zahran, Amman 11183, Jordan
| | - Dmour Awad
- Department of Orthopaedics, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iasi 700115, Romania
- Orthopaedics Clinic, Clinical Emergency Hospital Sf Spiridon, Iasi 700111, Romania
| | - Alexa Ovidiu
- Department of Orthopaedics, University of Medicine and Pharmacy ‘Grigore T. Popa’, Iasi 700115, Romania
- Orthopaedics Clinic, Clinical Emergency Hospital Sf Spiridon, Iasi 700111, Romania
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
d'Ailly PN, Mulders MA, Coert JH, Schep NW. The Current Role of Arthroscopy in Traumatic Wrist Injuries: An Expert Survey. J Wrist Surg 2023; 12:192-198. [PMID: 37223380 PMCID: PMC10202572 DOI: 10.1055/s-0042-1750875] [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: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 10/16/2022]
Abstract
Background Wrist arthroscopy has become increasingly popular for diagnosing and treating traumatic wrist injuries. How wrist arthroscopy has influenced the daily practice of wrist surgeons remains unclear. The objective of this study was to evaluate the role of wrist arthroscopy for the diagnosis and treatment of traumatic wrist injuries among members of the International Wrist Arthroscopy Society (IWAS). Methods An online survey was conducted among IWAS members between August and November 2021 with questions regarding the diagnostic and therapeutic importance of wrist arthroscopy. Questions focused on traumatic injuries of the triangular fibrocartilage complex (TFCC) and scapholunate ligament (SLL). Multiple-choice questions were presented in the form of a Likert scale. The primary outcome was respondent agreement, defined as 80% answering similarly. Results The survey was completed by 211 respondents (39% response rate). The majority (81%) were certified or fellowship-trained wrist surgeons. Most respondents (74%) had performed over 100 wrist arthroscopies. Agreement was reached on 4 of the 22 questions. It was agreed that the outcomes of wrist arthroscopy strongly depend on surgeons' experience, that there is sufficient evidence for the diagnostic purposes of wrist arthroscopy, and that wrist arthroscopy is better than magnetic resonance imaging (MRI) for diagnosing TFCC and SLL injuries. No agreement was reached on the preferred treatment of any type of TFCC or SLL injury. Conclusion There is agreement that wrist arthroscopy is superior to MRI for diagnosing traumatic TFCC and SLL injuries, yet experts remain divided on the optimal management. Guidelines need to be developed for the standardization of indications and procedures. Level of Evidence This is a Level III study.
Collapse
Affiliation(s)
- Philip N. d'Ailly
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Marjolein A.M. Mulders
- Department of Trauma Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - J. Henk Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels W.L. Schep
- Department of Hand and Trauma Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | | |
Collapse
|
10
|
d'Ailly PN, Deugd C, Schep NWL, Kuijper TM, Kok MR, Willemze A, Coert JH, de Jong PHP, Lam-Tse WK, van der Helm-van Mil AHM, Tchetverikov I, Weel-Koenders AEAM, Bisoendial RJ. Arthroscopic synovectomy versus intra-articular injection of corticosteroids for the management of refractory psoriatic or rheumatoid arthritis of the wrist: study protocol for a randomized controlled trial (ARCTIC trial). Trials 2023; 24:229. [PMID: 36966310 PMCID: PMC10039772 DOI: 10.1186/s13063-023-07129-y] [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: 07/13/2022] [Accepted: 01/31/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are inflammatory diseases that often affect the wrist and, when affected, can lead to impaired wrist function and progressive joint destruction if inadequately treated. Standard care consists primarily of disease-modifying anti-rheumatic drugs (DMARDs), often supported by systemic corticosteroids or intra-articular corticosteroid injections (IACSI). IACSI, despite their use worldwide, show poor response in a substantial group of patients. Arthroscopic synovectomy of the wrist is the surgical removal of synovitis with the goal to relieve pain and improve wrist function. The primary objective of this study is to evaluate wrist function following arthroscopic synovectomy compared to IACSI in therapy-resistant patients with rheumatoid or psoriatic arthritis. Secondary objectives include radiologic progress, disease activity, health-related quality of life, work participation and cost-effectiveness during a 1-year follow-up. METHODS This protocol describes a prospective, randomized controlled trial. RA and PsA patients are eligible with prominent wrist synovitis objectified by a rheumatologist, not responding to at least 3 months of conventional DMARDs and naïve to biological DMARDs. For 90% power, an expected loss to follow-up of 5%, an expected difference in mean Patient-Rated Wrist Evaluation score (PRWE, range 0-100) of 11 and α = 0.05, a total sample size of 80 patients will be sufficient to detect an effect size. Patients are randomized in a 1:1 ratio for arthroscopic synovectomy with deposition of corticosteroids or for IACSI. Removed synovial tissue will be stored for an ancillary study on disease profiling. The primary outcome is wrist function, measured with the PRWE score after 3 months. Secondary outcomes include wrist mobility and grip strength, pain scores, DAS28, EQ-5D-5L, disease progression on ultrasound and radiographs, complications and secondary treatment. Additionally, a cost-effectiveness analysis will be performed, based on healthcare costs (iMCQ questionnaire) and productivity loss (iPCQ questionnaire). Follow-up will be scheduled at 3, 6 and 12 months. Patient burden is minimized by combining study visits with regular follow-ups. DISCUSSION Persistent wrist arthritis continues to be a problem for patients with rheumatic joint disease leading to disability. This is the first randomized controlled trial to evaluate the effect, safety and feasibility of arthroscopic synovectomy of the wrist in these patients compared to IACSI. TRIAL REGISTRATION Dutch trial registry (CCMO), NL74744.100.20. Registered on 30 November 2020. CLINICALTRIALS gov NCT04755127. Registered after the start of inclusion on 15 February 2021.
Collapse
Affiliation(s)
- P N d'Ailly
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands.
| | - C Deugd
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - N W L Schep
- Department of Surgery, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - T M Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - M R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - A Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
| | - J H Coert
- Department of Plastic and Reconstructive Surgery, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - P H P de Jong
- Department of Rheumatology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - W K Lam-Tse
- Department of Rheumatology, Franciscus Gasthuis en Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - I Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
| | - A E A M Weel-Koenders
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - R J Bisoendial
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
- Department of Immunology, Erasmus Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
11
|
Gvozdenovic R, Hessler Simonsen S. A modified arthroscopic ulnar tunnel technique for foveal triangular fibrocartilage complex injury. J Plast Surg Hand Surg 2023; 57:308-314. [PMID: 35533690 DOI: 10.1080/2000656x.2022.2070179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Arthroscopically assisted techniques for the treatment of foveal triangular fibrocartilage complex (TFCC) injuries offer a less invasive option. Reports of the ulnar tunnel technique on a larger patient population are needed. This prospective cohort study of 44 patients aimed to evaluate the clinical and patient-reported outcome after arthroscopic foveal re-attachment using a novel, modified ulnar tunnel technique. Furthermore, preoperative magnetic resonance imaging findings were compared with the findings from the arthroscopic evaluation. History of ulnar sided wrist pain, positive fovea-sign at the clinical examination and positive hook test at the surgery were the main inclusion criteria for the study. Pain, grip strength, wrist motion and patient-reported outcomes were assessed pre-and postoperatively. The follow-up of this study was 31 months (range 18-48). No complications occurred during the surgery. All outcomes improved besides the range of motion, which remained unchanged. Pain on a visual analogue scale was 63 before, and 14 after the surgery (p = .0004). Pre- and postoperative values of Disability of Arm, Shoulder and Hand Questionnaire were 41/6, respectively (p = .007). Grip strength, measured in Kilogram-force were 29 and 36, pre-and postoperatively (p = .0004). Conspicuously, all patients achieved stability. Six patients needed re-operation, three for renewed injury. Thirty-nine of 44 patients scored excellent or good on the satisfaction score. We found the devised method to be with fewer complications and with favourable results compared with other techniques for the treatment of TFCC injuries. Level of evidence: III.
Collapse
Affiliation(s)
- Robert Gvozdenovic
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark.,Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sabine Hessler Simonsen
- Department of Hand Surgery, Herlev/Gentofte University Hospital of Copenhagen, Hellerup, Denmark
| |
Collapse
|