Importance of distal radioulnar joint arthroscopy for evaluating the triangular fibrocartilage complex

Yamamoto, Masayuki; S, Koh; Tatebe, Masahiro; Shinohara, Takaaki; Shionoya, Kaori; Hirata, Hitoshi; Nakamura, Ryogo

doi:10.1007/s00776-009-1445-5

Cited by 29 publications

(21 citation statements)

References 21 publications

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“…Table 3. Methodologic quality of the included studies Cerofolini et al [6] Cooney [8] Dwek et al [9] Iordache et al [10] Levinsohn and Palmer [13] Mahmood et al [15] Tanaka et al [24] Weiss et al [28] Yamamoto et al [29] Selection (1) Representativeness of the exposed cohort Yamamoto et al [29] Outcome ( …”

Section: Appendixmentioning

confidence: 99%

Prevalence of Triangular Fibrocartilage Complex Abnormalities Regardless of Symptoms Rise With Age: Systematic Review and Pooled Analysis

Chan

Teunis

Ring

2014

Clin Orthop Relat Res

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Background Triangular fibrocartilage complex abnormalities seem to be more common with age, but the degree to which this is so, and the degree to which the presence of an abnormality is associated with symptoms, are topics of controversy. Questions/purposes We wished to perform a systematic review to determine the prevalence of triangular fibrocartilage complex abnormalities, and to determine if the prevalence of abnormalities are greater with increasing age. In addition, we stratified age groups based on symptoms. Methods We searched MEDLINE, EMBASE, and the Cochrane Library through August 15, 2013. Studies that reported triangular fibrocartilage complex abnormalities by age were included. Fifteen studies including 977 wrists met our criteria and reported a total of 368 (38%) triangular fibrocartilage complex abnormalities. Eight studies included symptomatic patients; the remainder studied cadavers (six studies) or asymptomatic volunteers (one study). Patients were divided into four age groups (\30, 30-49, 50-69, and 70 years and older) for pooled analysis, comparing the proportions of patients with and without abnormalities between groups using chi-square analysis. We also evaluated the proportions after stratifying each age group by symptoms. Results Overall, the prevalence of triangular fibrocartilage complex abnormalities increased with age, from 27% (80/301) in patients younger than 30 years to 49% (130/ 265) in patients 70 years and older (p \ 0.001), odds ratio (OR), 2.7, 95% CI, 1.9-3.8 (p \ 0.001). In asymptomatic patients, triangular fibrocartilage complex prevalence abnormality increased from 15% (24/159) to 49% (129/ 263) in the same age groups (p \ 0.001), OR, 5.4, 95% CI, 3.3-8.9 (p \ 0.001). For symptomatic patients prevalence ranged from 39% (56/142) to 70% (14/20) in patients between 50 and 69 years old (p\0.034), OR, 3.6, 95% CI, 1.3-9.9 (p \ 0.014). Conclusion Triangular fibrocartilage complex abnormalities are common in symptomatic and asymptomatic wrists, and they are increasingly common with age. As in all situations where abnormalities are so common that they may be incidental, we need (1) a reliable and accurate method for determining whether these abnormalities are the cause of symptoms; and (2) evidence that treatment of these abnormalities improves symptoms better than placebo.

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Section: Appendixmentioning

confidence: 99%

Prevalence of Triangular Fibrocartilage Complex Abnormalities Regardless of Symptoms Rise With Age: Systematic Review and Pooled Analysis

Chan

Teunis

Ring

2014

Clin Orthop Relat Res

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“…We also performed DRUJ arthroscopy with a technique that allowed us to confirm detachment of the TFCC at the fovea. 29 After ulnar impingement syndrome had been diagnosed, the extent of relative ulnar length was determined. Usually the contralateral side was referred to for determining the length of shortening.…”

Section: Surgical Techniquementioning

confidence: 99%

“…A longitudinal mark was also made to ensure proper rotational alignment after osteotomy. 29 Efforts were made to minimize damage to the periosteum, to allow better bone healing. To avoid compromising DRUJ stability, the pronator muscle and interosseous membrane were left unstripped.…”

Section: Surgical Techniquementioning

confidence: 99%

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

et al. 2014

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The ulnar side of the wrist has been referred to as the "black box" of the wrist, and pathologies of this region have been compared with those of low back pain, 1,2 given the complex anatomy, myriad differential diagnosis, and varied treatment outcomes. Ulnar-sided wrist pain and arise from an acute traumatic injury or a chronic degenerative condition. Common causes of ulnar-sided wrist pain include isolated injuries to the triangular fibrocartilage complex (TFCC) or lunotriquetral ligament as well as ulnar impaction syndrome, which consists of a combination of these 2 conditions along with an Keywords ► ulnar shortening osteotomy ► ulnar-sided wrist pain ► TFCC ► DRUJ ► arthroscopy AbstractBackground The purpose of ulnar shortening osteotomy is literally to shorten the ulna. It can tighten the triangular fibrocartilage complex (TFCC), ulnocarpal ligaments, and interosseous membrane. Nowadays, this method is used to treat ulnar-sided wrist pain, for which we have also started to use a treatment algorithm. The purpose of this study was to review the long-term and clinical results based on our algorithm. Materials and Methods We retrospectively reviewed 30 patients with ulnocarpal impaction syndrome after a minimum follow-up of 5 years (Group A) and then retrospectively evaluated 66 patients with recalcitrant ulnar wrist pain treated based on our algorithm (Group B). Description of Technique Ulnocarpal abutment was confirmed arthroscopically. The distal ulna was approached through a longitudinal incision between the extensor carpi ulnaris and flexor carpi ulnaris. We performed a transverse resection of the ulna fixed with a small locking compression plate. The contralateral side served as the reference for the length of shortening (mean, 2.4 mm; range, 1-5 mm). Disappearance of ulnar abutment was then confirmed again arthroscopically. Results (Group A) Most patients showed good long-term clinical results. About half of the patients showed a bony spur at the distal radioulnar joint (DRUJ), but the clinical results did not significantly correlate with presence of bony spurs. Radiological parameters wre not related to the presence of bony spurs. (Group B) Twenty-four of the 66 patients investigated prospectively underwent an ulnar shortening osteotomy, with all showing good clinical results at 18 months postoperatively. Conclusions Ulnar shortening osteotomy can change the load of the ulnar side of the wrist and appears useful for ulnar-sided wrist pain in the presence of ulnar impaction. Level of evidence IV

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“…30 Yamamoto et al demonstrated that pathological findings of the proximal surface of the articular disk tended to relate to ulnar wrist pain, 29 and that, in 30% of all patients, DRUJ arthroscopies revealed pathological findings that could not be identified with a radiocarpal arthroscopy. 31 …”

Section: Repair Of the Ulnar Side (Palmer 1b)mentioning

confidence: 99%

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair

2017

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SYNOPSIS This review shows trends in triangular fibrocartilage complex (TFCC) repair since 1990 by geographic area and year. The repair methods presented in the literature were inside-out, outside-in, all-inside, and open repair. The outside-in technique was reported most often for ulnar-side tears whereas the inside-out technique was reported most frequently for radial-side tears. Recently, a foveal reattachment technique for ulnar-side tears has garnered attention and has been reported with increasing frequency, especially in Asia, because the deepest portion of TFCC, attached to fovea, plays a key role in stabilizing the distal radioulnar joint (DRUJ). Understanding these trends can help us to best treat TFCC tears.

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Importance of distal radioulnar joint arthroscopy for evaluating the triangular fibrocartilage complex

Cited by 29 publications

References 21 publications

Prevalence of Triangular Fibrocartilage Complex Abnormalities Regardless of Symptoms Rise With Age: Systematic Review and Pooled Analysis

Prevalence of Triangular Fibrocartilage Complex Abnormalities Regardless of Symptoms Rise With Age: Systematic Review and Pooled Analysis

Ulnar Shortening Osteotomy for Ulnar-Sided Wrist Pain

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair

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