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Koeyvoets CEA, Teunissen JS, Feitz R, Hovius S, Hagert E, van der Heijden EPA. Biomechanical Outcomes of Surgically Repaired TFCC Palmer Type 1B Tears: A Systematic Review of Cadaver Studies. Hand (N Y) 2023; 18:1258-1266. [PMID: 35815648 PMCID: PMC10617480 DOI: 10.1177/15589447221105546] [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: 02/10/2023]
Abstract
BACKGROUND Palmer type 1B triangular fibrocartilage complex (TFCC) tears are a common cause of distal radioulnar joint (DRUJ) instability. Unfortunately, the best surgical technique for TFCC reinsertion is still unknown, and up to a quarter of patients report instability after repair. The purpose of this systematic review of cadaver studies was to compare the biomechanical outcomes of different surgical techniques used for Palmer 1B TFCC tears. METHODS A systemic review of all cadaver studies published before January 2022 was performed using the PubMed and EMBASE databases. Only cadaver studies on reinsertion techniques for Palmer type 1B lesions were included. Biochemical outcome parameters evaluated were stability of the DRUJ and strength of the repair. RESULTS A total of 248 articles were identified. Five articles fulfilled the inclusion criteria. Four different surgical techniques were identified. In 3 studies, transosseous tunnel repair was tested and resulted in the most stable DRUJ and strongest TFCC repair compared with the suture anchor repair, the peripheral capsular repair, and the outside-in repair. CONCLUSIONS These results suggest that the transosseous tunnel repair might be a good technique for restoring DRUJ stability. However, more cadaver studies are needed to identify the most optimal technique.
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Affiliation(s)
| | | | - Reinier Feitz
- Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
- Xpert Clinics, Amsterdam, The Netherlands
| | - Steven Hovius
- Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
- Xpert Clinics, Rotterdam, The Netherlands
| | - Elisabeth Hagert
- Karolinska Institutet, Stockholm, Sweden
- H.M. Queen Sophia Hospital, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
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Thillemann JK, De Raedt S, Petersen ET, Puhakka KB, Hansen TB, Stilling M. Normal Values of Distal Radioulnar Joint Kinematics during a Dynamic Press Test. J Wrist Surg 2022; 11:406-415. [PMID: 36339081 PMCID: PMC9633146 DOI: 10.1055/s-0041-1740486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/09/2021] [Indexed: 12/30/2022]
Abstract
Background Measurement of in vivo distal radioulnar joint (DRUJ) pathomechanics during simple activities can represent the disability experienced by patients and may be useful in diagnostics of DRUJ instability. A first step is to describe the physiological normal limits for DRUJ kinematics in a reproducible and precise test setup, which was the aim of this study. Methods DRUJ kinematics were evaluated in 33 participants with dynamic radiostereometry (RSA) while performing a standardized press test examination. AutoRSA software was used for image analyses. Computed tomography (CT) forearm bone models were generated, and standardized anatomical axes were applied to estimate kinematic outcomes including, DRUJ translation, DRUJ position ratio, and changes in ulnar variance. Repeatability of dynamic RSA press test double examinations was evaluated to estimate the precision and intraclass correlation coefficient (ICC) test-retest agreement. Results The maximum force during the press test was 6.0 kg (95% confidence interval [CI]: 5.1-6.9), which resulted in 4.7 mm (95% CI: 4.2-5.1) DRUJ translation, DRUJ position ratio of 0.40 (95% CI: 0.33-0.44), and increase in ulnar variance of 1.1 mm (95% CI: 1.0-1.2). The mean maximum DRUJ translation leveled off after a 5 kg force application. The DRUJ translation ICC coefficient was 0.93 within a prediction interval of ± 0.53mm. Conclusions This clinical study demonstrates the normal values of DRUJ kinematics and reports excellent agreement and high precision of the press tests examination using an automated noninvasive dynamic RSA imaging method based on patient-specific CT bone models. The next step is the application of the method in patients with arthroscopic verified triangular fibrocartilage complex injuries. Level of Evidence This is a Level IV, case series study.
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Affiliation(s)
- Janni Kjærgaard Thillemann
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Sepp De Raedt
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- NRT X-RAY A/S, Hasselager, Denmark
| | - Emil Toft Petersen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
| | - Katriina Bøcker Puhakka
- Department of Radiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Radiology, Regional Hospital Horsens, Horsens, Denmark
| | - Torben Bæk Hansen
- Department of Orthopaedics, University Clinic for Hand, Hip and Knee Surgery, Hospital Unit West, Holstebro, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Maiken Stilling
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
- AutoRSA Research Group, Orthopaedic Research Unit, Aarhus University Hospital, Aarhus N, Denmark
- Department of Orthopaedic Surgery, Aarhus University, Aarhus N, Denmark
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