Functional Outcomes Are Similar After Early and Late Arthroscopic One-Tunnel Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears

Park, Ji Hun; Lim, Jung Wook; Kwon, Young Woo; Kang, Jong Woo; Choi, In Cheul; Park, Jong Woong

doi:10.1016/j.arthro.2020.03.026

Cited by 23 publications

(28 citation statements)

References 27 publications

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“…Park et al described that creating the bone tunnel induces bone bleeding, this may introduce osteo-inductivity and healing factors have been demonstrated to enhance organization of collagen and soft tissue reattachment to the bone. 11 We can realize this theory even in the chronic cases of TFCC foveal tear. A 48-year-old woman diagnosed ulnocarpal abutment syndrome with TFCC foveal tear underwent ulnar shortening osteotomy and TFCC reattachment transosseously to the fovea.…”

Section: Why Is the Transosseous Repair Effective?mentioning

confidence: 89%

Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage

Abe¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Section: Why Is the Transosseous Repair Effective?mentioning

confidence: 89%

Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage

Abe¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…Recent study of 80 one-anchor, twosuture TFCC foveal repairs demonstrated excellent 2-year outcomes, even in the subgroup done more than a year posttrauma and only two patients in this series had residual instability. 30 Owing to concerns about suboptimal outcomes from TFCC repairs in our practice, patients in this study were offered arthroscopic thermal annealing of the secondary DRUJ stabilizers for chronic instability, regardless of severity, as an alternative to open treatment. 11 Targeting the superficial radioulnar and ulnocarpal ligaments as well as the dorsoulnar wrist capsule with heat energy using a radiofrequency probe produces contraction of those structures and observable narrowing of the ulnocarpal joint.…”

Section: Discussionmentioning

confidence: 99%

Experience with Diagnosis and Management of Distal Radioulnar Joint Instability

et al. 2021

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Objective The aim of this study is to review our cumulative experience with diagnosis and treatment of distal radioulnar joint (DRUJ) instability and to present our treatment algorithm. Materials and Methods Retrospective review identified 112 patients who had 126 episodes of care for DRUJ instability at a single institution over a 21-year period. Those diagnosed acutely or subacutely were treated with immobilization of the wrist and elbow for 6 weeks, while those with chronic instability had anatomic reconstruction of the dorsal and palmar radioulnar ligaments with tendon autograft or an alternative arthroscopic treatment with our thermal annealing technique. Short-term treatment failures and surgical complications were recorded. Nonparametric statistical tests were used to analyze key long-term outcome measures including ulnar wrist pain and DRUJ stability indicated by the dorsopalmar stress test. Results At mean 7-year follow-up, eight patients in the acute-injury cohort had statistically significant improvements in wrist pain and DRUJ instability (p < 0.001). In both the 22-patient anatomic reconstruction cohort and the 37-patient arthroscopically treated group, there were also statistically significant improvements in wrist pain and DRUJ stability (p < 0.001) at mean 9-year follow-up. The majority of patients in all three groups was satisfied with treatment outcome, though some required secondary procedures. Conclusion Early clinical diagnosis of DRUJ instability using the dorsopalmar stress test provides an opportunity for effective nonsurgical treatment. For chronic presentation, we recommend our arthroscopic thermal annealing technique for mild or moderate instability and open anatomic reconstruction of the radioulnar ligaments for severe instability. Level of Evidence This is a Level IV, therapeutic study.

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“…Another concern of this technique is the risk of TFCC injury while attempting passing of the K-wire or maintaining the targeting device over the TFCC disc during ulnar tunneling. 7 , 8 , 10 , 11 In contrast, reattachment using a suture anchor requires less dissection over the ulnar wrist, which may result in less tissue injury, especially on the TFCC disc.…”

Section: Discussionmentioning

confidence: 99%

“… 3 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Previous reports have described the outside-in TFCC suturing technique for foveal reattachment, accessing the TFCC from a mini-open approach at the base of the ulnar styloid. 5 , 7 , 8 , 10 , 11 However, few reports have described the inside-out technique. 6 , 12 Thus, we herein present our technique of arthroscopic-assisted inside-out foveal reattachment of the TFCC.…”

mentioning

confidence: 99%

Arthroscopic-Assisted Inside-Out Foveal Reattachment of Triangular Fibrocartilage Complex

Waitayawinyu

2021

Arthroscopy Techniques

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The dorsal and palmar radioulnar ligaments are the deep components of the triangular fibrocartilage complex (TFCC), which provides stability to the distal radioulnar joint (DRUJ). In patients with DRUJ instability, arthroscopic procedures are currently focused on reattachment of the deep components of the TFCC to the fovea of the ulnar head. TFCCefoveal reattachment can be performed either by using the transosseous technique with creation of a bone tunnel or by suturing to a bone anchor. Most previous studies of the TFCC suture method have used an outside-in technique. We herein present an arthroscopic inside-out TFCCefoveal reattachment technique with a bony anchor for the treatment of DRUJ instability. This technique has novel advantages, including less exposure, less soft-tissue dissection, and greater ease of TFCC suturing. This procedure may thus be considered another good option for the treatment of TFCC injury with DRUJ instability.

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Functional Outcomes Are Similar After Early and Late Arthroscopic One-Tunnel Transosseous Repair of Triangular Fibrocartilage Complex Foveal Tears

Cited by 23 publications

References 27 publications

Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage

Editorial Commentary: Guidelines for Wrist Triangular Fibrocartilage Complex Foveal Tears: A Compass for a Broad Voyage

Experience with Diagnosis and Management of Distal Radioulnar Joint Instability

Arthroscopic-Assisted Inside-Out Foveal Reattachment of Triangular Fibrocartilage Complex

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