Foveal TFCC Tear Classification and Treatment

Atzei, Andrea; Luchetti, Riccardo

doi:10.1016/j.hcl.2011.05.014

Cited by 212 publications

(204 citation statements)

References 33 publications

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“…1,2 The distal hammock structure and the ulnar collateral ligaments are distal components, inserting into the ulnar styloid. The palmar and dorsal portions of the RUL originate from the distal margin of the sigmoid notch and converge to attach to the ulna.…”

Section: Historical Perspectivementioning

confidence: 99%

“…Anatomic TFCC repair into the fovea is recommended for proximal or complete tears. 2 Conventional repair techniques for peripheral TFCC tears involve repair to the dorsal or ulnar joint capsule. They do not reconstitute the foveal origin, and instability may persist.…”

Section: Historical Perspectivementioning

confidence: 99%

“…This is compared with the contralateral side, and abnormal translation suggests a complete TFCC tear. 2,13 Although it is commonly considered that dorsal instability is much more common, it is the authors' experience that volar instability is often overlooked. Volar instability is best assessed in supination, where there is an abnormal prominence of the ulnar head on the volar aspect of the wrist.…”

Section: Indications/contraindations Clinical Assessmentmentioning

confidence: 99%

“…14 Magnetic resonance imaging arthrogram improves the accuracy of diagnosing a foveal tear; however, there are some cases where there is no leakage of contrast, as the entire TFCC has been avulsed from the fovea. 2 We often perform a DRUJ arthrogram (instead of radiocarpal), as this will confirm the tear of the foveal attachment of the TFCC (Figs. 1A, B).…”

Section: Indications/contraindations Clinical Assessmentmentioning

confidence: 99%

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Anatomic Foveal Reconstruction of the Triangular Fibrocartilage Complex With a Tendon Graft

Bain

McGuire

Lee

et al. 2014

Techniques in Hand &Amp; Upper Extremity Surgery

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An acute injury to the triangular fibrocartilage complex (TFCC) with avulsion of the foveal attachment can produce distal radioulnar joint (DRUJ) instability. The avulsed TFCC is translated distally so the footprint will be bathed in synovial fluid from the DRUJ and will become covered in synovitis. If the TFCC fails to heal to the footprint, then persistent instability can occur. The authors describe a surgical technique indicated for the treatment of persistent instability of the DRUJ due to foveal detachment of the TFCC. The procedure utilizes a loop of palmaris longus tendon graft passed through the ulnar aspect of the TFCC and into an osseous tunnel in the distal ulna to reconstruct the foveal attachment. This technique provides stability of the distal ulna to the radius and carpus. We recommend this procedure for chronic instability of the DRUJ due to TFCC avulsion, but recommend that suture repair remain the treatment of choice for acute instability. An arthroscopic assessment includes the trampoline test, hook test, and reverse hook test. DRUJ ballottement under arthroscopic vision details the direction of instability, the functional tear pattern, and unmasks concealed tears. If the reverse hook test demonstrates a functional instability between the TFCC and the radius, then a foveal reconstruction is contraindicated, and a reconstruction that stabilizes the radial and ulnar aspects of the TFCC is required. The foveal reconstruction technique has the advantage of providing a robust anatomically based reconstruction of the TFCC to the fovea, which stabilizes the DRUJ and the ulnocarpal sag.Key Words: triangular fibrocartilage complex, foveal tear, DRUJ instability, wrist arthroscopy, TFCC repair (Tech Hand Surg 2014;18: 92-97) HISTORICAL PERSPECTIVEThe triangular fibrocartilage complex (TFCC) is a complex 3-dimensional structure made up of the proximal triangular ligament or the radioulnar ligaments (RUL), the distal hammock structure, and the ulnar collateral ligaments. 1,2 The distal hammock structure and the ulnar collateral ligaments are distal components, inserting into the ulnar styloid. The palmar and dorsal portions of the RUL originate from the distal margin of the sigmoid notch and converge to attach to the ulna. As the ligaments extend ulnarly, they divide into a distal component that attaches to the ulnar styloid and a proximal component that attaches to the fovea. [3][4][5][6] The articular disk extends from the ulnar edge of the lunate fossa at the distal rim of the sigmoid notch and blends peripherally with the RUL.The foveal insertion of the TFCC contributes more to DRUJ stability than the styloid insertion because of its closer relationship to the rotational axis of the forearm. 4 In fractures of the ulnar styloid with disruption of the distal components of TFCC, patients may not experience DRUJ instability due to an intact foveal attachment. 7 However, disruption of the TFCC at its foveal attachment can result in DRUJ instability. 3,5 Palmer 8 proposed a classification syst...

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Section: Historical Perspectivementioning

confidence: 99%

Section: Historical Perspectivementioning

confidence: 99%

Section: Indications/contraindations Clinical Assessmentmentioning

confidence: 99%

Section: Indications/contraindations Clinical Assessmentmentioning

confidence: 99%

See 2 more Smart Citations

Anatomic Foveal Reconstruction of the Triangular Fibrocartilage Complex With a Tendon Graft

Bain

McGuire

Lee

et al. 2014

Techniques in Hand &Amp; Upper Extremity Surgery

View full text Add to dashboard Cite

show abstract

“…Subsequently, Atzei et al proposed a treatment-oriented approach to describing TFCC tears [40]. Their classification divides the TFCC into three primary structures: the proximal triangular ligament (ligamentum subcruentum), the distal hammock structure (superficial RUL), and the ulnar collateral ligament.…”

Section: Classificationmentioning

confidence: 99%

Ulnar-sided wrist pain in the athlete (TFCC/DRUJ/ECU)

Pang

Yao

2017

Curr Rev Musculoskelet Med

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Purpose of review The goal of this manuscript is to review key historic and recent literature regarding extensor carpi ulnaris (ECU), triangular fibrocartilage complex (TFCC) and distal radioulnar joint (DRUJ) injuries, particularly in athletes. Recent findings Many recent studies examining the ECU focus on clinical and radiographic diagnosis. Several physical exam findings are described in addition to the use of MRI and US. Imaging studies must be clinically correlated due to high incidence of findings in asymptomatic patients.In regard to the TFCC/DRUJ, there are numerous recent studies that support the use of MRA as an adjunctive diagnostic study. There are also a number of repair constructs that are described for the various different kinds of TFCC pathology reviewed here. Summary In summary, there are a number of options for the diagnosis and treatment of ulnar-sided wrist pain. Patient factors, especially in the athletic population, must be taken into account when approaching any patient with these pathologies.

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