Another Light in the Dark: Review of a New Method for the Arthroscopic Repair of Triangular Fibrocartilage Complex

Abstract

The triangular fibrocartilage complex (TFCC) is an anatomically and biomechanically important structure. Repair of radial-sided TFCC tear has previously been challenging. We designed a new method of radial-sided TFCC tear repair and found that it was also applicable for ulnar-sided TFCC tear repair. From October 2006 to December 2010, 10 patients underwent this operation and were reviewed: 9 men and 1 woman, with a mean age of 33.9 years. Average postoperative follow-up was 8 months. We graded results according to the Mayo modified wrist score. We rated 2 of the 10 patients (20%) as "excellent," 3 (30%) as "good," and 5 (50%) as "fair." The 5 patients who were rated as "fair" returned to regular jobs or had restricted employment. Based on this small sample, we recommend that this technique be considered an alternative method for TFCC repair.

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair

“…34–41 The repair of radial-side tears has been reported since the 1990s. However, the annual number of articles that reported the repair of radial side tears did not increase over the time period covered in our literature search (Figure 2 and Figure 11).…”

“…The inside-out technique was most commonly used (6/10 articles). 34,35,37,41,44 The inside-out technique is performed by using trans-osseous sutures through the distal radius in ulnar to radial direction (Figure 12). The suture is passed through the cannula, central rim of the TFCC, and bone tunnel, and then tied over the radius.…”

“…The repair of radial-side TFCC tear was mainly reported in North America and Asia. 34,35,37–41,43 Only one paper was from Europe, showing the outside-in technique. 36 …”

Results of arthroscopic repair of triangular fibrocartilage complex peripheral tears (Palmer type 1B)

“…[1] Palmer, sınıflamasında tip 1 yırtıkların travmatik nedenlere bağlı geliştiğini ve tip 1B yırtıkların ulnar taraflı periferal yırtıklar olduğunu tariflenmişdir. [2,3] TFKK'nin periferik kısmının iyi kanlanması nedeni ile TFKK Palmer tip 1B yırtıklarının tamiri iyi sonuçlar vermektedir. [4] Geçmiş yıllarda TFKK yırtıkları açık teknikler ile tedavi edilirken günümüz-de artroskopik teknikler ile de bu yırtıkların etkin bir şekilde tedavisi yapılabilmektedir.…”

Traumatic Triangular Fibrocartilage Complex Injuries and Instability of the Distal Radioulnar Joint

“…1,2,12,16,20) 현재 Palmer의 분류에 의해 TFCC 손상의 분류가 이루어졌는 데, 변연부 심부 파열의 경우 DRUJ의 불안정성을 유발할 수 있음 이 알려지면서 최근에는 Atzei 분류를 통한 수정된 분류가 유용하 게 사용되고 있다. [3][4][5][6][7][8][9][10][11]21) 분 류 Palmer와 Werner 1) 는 손목의 TFCC가 관절 연골판(articular disc), 수장부 및 수배부 요척인대(the volar and dorsal radioulnar ligaments), 관절판(meniscus homologue), 척측 측부인대(ulnar collateral ligament), 척측 수근 신근의 건막(the sheath of the ECU), 척골-월상인대(ulnolunate ligament), 척골-삼각인대(ulnotriquetral ligament)로 구성되어 있다고 기술하였다. 1,17)…”