Comparison between open and arthroscopic-assisted foveal triangular fibrocartilage complex repair for post-traumatic distal radio-ulnar joint instability

Abstract

The aim of this study was to assess the objective and subjective functional outcomes after foveal reattachment of proximal or complete ulnar-sided triangular fibrocartilage complex lesions by two surgical procedures: an open technique or an arthroscopically assisted repair. The study was done prospectively on 49 wrists affected by post-traumatic distal radio-ulnar joint instability. Twenty-four patients were treated with the open technique (Group 1) and 25 by the arthroscopically assisted technique (Group 2). Magnetic resonance imaging demonstrated a clear foveal detachment of the triangular fibrocartilage complex in 67% of the cases. Arthroscopy showed a positive ulnar-sided detachment of the triangular fibrocartilage complex (positive hook test) in all cases. Distal radio-ulnar joint stability was obtained in all but five patients at a mean follow-up of 6 months. Both groups had improvement of all parameters with significant differences in wrist pain scores, Mayo wrist score, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Rated Wrist/Hand Evaluation questionnaire scores. There were no significant post-operative differences between the two groups in the outcome parameters except for the Disability of the Arm Shoulder and Hand questionnaire score, which was significantly better in Group 2 (p < 0.001).

An Italian Experience Delving Inside the Wrist

“…For instance, open mini -invasive surgical techniques, alongside those arthroscopic repair techniques of the triangular and/or scafo-lunate ligament 25 render similar result, as you can see in publications such as those listed in my bibliography. 26 These results are also valid for ligament reconstruction techniques 27 ; and for salvage procedures. 28 Nevertheless, some surgical wrist techniques are, and remain to be, dominated by the open technique.…”

A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment

“…However, each noted that very few high-quality studies had been performed and that all studies selected had methodological issues with a high risk of bias. [55][56][57] Miwa et al showed that in 1B and 1D lesions, arthroscopic suture repair restored anatomic continuity, was easy to perform, and had similar results to debridement. By the Minami evaluation, suture repair had 16 (47%) excellent, 15 good, 2 fair, and 1 poor results.…”

Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex

“…In a recent paper, Luchetti et al 38 showed that both open and arthroscopic techniques are equally valuable in repairing foveal TFCC tears and restoring DRUJ stability, though with significantly better subjective outcomes for the arthroscopic group.…”