Arthroscopic Foveal Repair of Triangular Fibrocartilage Complex Peripheral Lesion With Distal Radioulnar Joint Instability

Atzei, Andrea; Rizzo, Alessandra; Luchetti, Riccardo; Fairplay, Tracy

doi:10.1097/bth.0b013e3181901b1

Cited by 132 publications

(103 citation statements)

References 29 publications

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“…This portal is not for visualization of the DRUJ constitutions. Atzei also reported a direct fovea portal which is just palmar to the ulnar styloid in the forearm in a supinated position for an arthroscope-assisted fovea repair of the TFCC [ 22 ] . This portal is also not for the scope.…”

Section: Portalsmentioning

confidence: 97%

Arthroscopy of the Distal Radioulnar Joint

Nakamura

Matsumura

Iwamoto

et al. 2014

Handchir Mikrochir plast Chir

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Wrist arthroscopy is now widely indicated for diagnosis and treatment of acute or chronic wrist pain, especially for triangular fibrocartilage complex (TFCC) lesions, as a gold standard. In most cases radiocarpal and midcarpal arthroscopy was performed, while DRUJ arthroscopy has been rarely performed because of its difficulties. Recent anatomic and biomechanical studies demonstrated that the radioulnar ligament (RUL), which is the proximal component of the TFCC facing to the DRUJ, is the primary stabilizer of the distal radioulnar joint (DRUJ). Rupture of the radioulnar ligament (RUL) at the fovea area, where it is the main attaching portion to the ulna and is the isometric point during forearm rotation as the rotation axis passes, is responsible for DRUJ instability. Although physical examination and imaging diagnosis may indicate a foveal detachment of the TFCC, DRUJ arthroscopy is potential for visualizing the RUL at the fovea. Role of DRUJ arthroscopy should be more important not only for diagnosis of rupture of the RUL but also for decision making of treatment option for RUL tear. DRUJ arthroscopy also demonstrates the joint surface of both the sigmoid notch and ulnar head, and the proximal surface of the TFCC.

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Section: Portalsmentioning

confidence: 97%

Arthroscopy of the Distal Radioulnar Joint

Nakamura

Matsumura

Iwamoto

et al. 2014

Handchir Mikrochir plast Chir

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“…Other techniques using a suture anchor to reattach the TFCC to the fovea are also reported with good results. [6][7][8][9][10] However, inserting the suture anchor into the fovea provides only a point contact for the TFCC foveal reattachment and occupies the bony surface of the TFCC footprint on which the TFCC should heal. In our technique, only one 1.6-mm osseous tunnel is created, but it allows 4 suture limbs to pass and reattach the TFCC back to the fovea.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some arthroscopic techniques to reattach a fovealavulsed TFCC have been reported as using the transosseous tunnel [1][2][3][4][5] or the suture anchor. [6][7][8][9][10] Iwasaki and Minami reported an arthroscopic technique of reattachment of the avulsed TFCC to the ulnar fovea by creating a 2.9-mm osseous tunnel from the ulnar neck to the fovea to pass the sutures.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Chen

2017

Arthroscopy Techniques

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The radioulnar ligament of the triangular fibrocartilage complex (TFCC), especially the deep fibers inserted at the ulnar fovea, is the key component for the distal radioulnar joint (DRUJ) stability. Traumatic injuries to the TFCC foveal insertion would cause DRUJ instability. Traditionally, arthroscopic techniques of the TFCC repair are suturing the ulnarsided disruption peripherally to the dorsal or ulnar capsule instead of suturing the TFCC to the fovea and thus fail to restore the DRUJ stability if the TFCC is detached from the fovea. Recently, some arthroscopic foveal repair techniques have been reported using a suture anchor or transosseous sutures to address the foveal tear. This technical note describes an arthroscopic transosseous technique to reattach the foveal-disrupted TFCC. A 1.6-mm small osseous tunnel is created on the radial border of the fovea and 4 sutures are passed into the tunnel by using a 16-gauge needle. The TFCC could be sutured arthroscopically with these 4 sutures and be compressed against the fovea. Our technique provides not only a good suture construct for TFCC foveal reattachment but also an anatomic contact surface between the torn TFCC and its foveal footprint for healing. We recommend this technique as an alternative for repairing TFCC foveal tear.T he radioulnar ligament of the triangular fibrocartilage complex (TFCC), especially the deep fibers inserted at the ulnar fovea, is the key component for the distal radioulnar joint (DRUJ) stability. Traumatic injuries to the TFCC foveal insertion would cause DRUJ instability. The aim of treatment for this foveal disruption is to reattach the disrupted radioulnar ligament to its foveal insertion. Recently, some arthroscopic techniques to reattach a torn TFCC to its foveal insertion have been reported using the transosseous tunnel 1-5 or using a suture anchor. 6-10 However, these techniques require 1 relatively large or 2 separate tunnels in the small ulnar head or a costly suture anchor. Thus, we present our arthroscopic transosseous TFCC repair technique to reattach the foveal-avulsed TFCC to its foveal footprint anatomically. Clinical Assessment of TFCC InjuryA clinical suspicion of TFCC foveal tear is based on the traumatic history of the involved wrist, positive ulnar fovea sign, and DRUJ laxity found in the DRUJ ballottement test. Routine radiograph examination is used to evaluate the ulnar variance, arthritis status of the ulnocarpal joint and DRUJ, and the possibly associated ulnar styloid fracture or nonunion. This clinical suspicion of TFCC foveal tear could also be illustrated by magnetic resonance imaging. Indications for SurgeryInitial conservative treatment with 4-week cast immobilization of forearm rotation and wrist range of motion is given for TFCC injuries that exhibit fair DRUJ stability. Surgery is indicated for TFCC injuries with failed conservative treatment or TFCC injuries with gross DRUJ instability that is supported by the magnetic resonance imaging evidence of TFCC foveal disruption. Poor TFCC tiss...

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“…Based on the arthroscopic findings, five classes of TFCC peripheral tears are recognized, and guidelines for specific treatment can be considered. 15 In degenerative lesions, the positive ulnar variance must be addressed in addition to debridement of the TFCC tear. Impaction syndrome may be treated surgically by an extraarticular ulna shortening or a wafer procedure.…”

mentioning

confidence: 99%