Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes

Fishman, Felicity G.; Barber, Jarrad; Lourie, Gary M.; Peljovich, Allan E.

doi:10.1097/bpo.0000000000001243

Cited by 15 publications

(23 citation statements)

References 20 publications

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“…Three studies administered patient reported outcome scores over the telephone. If the patients were not contactable or refused to participate in the study, the last clinical follow-up was used [ 23 , 24 , 25 ]. Three studies had at least one prospective clinical follow-up [ 26 , 27 , 28 ].…”

Section: Resultsmentioning

confidence: 99%

“…The overall study quality was very low with MINORS criteria ranging from 10 to 13 and the Modified Coleman Score (MCS) ranging from 34 to 56. Six papers reported solely on pediatric and adolescent cases [ 23 , 24 , 25 , 27 , 28 , 29 ], whereas two studies also reported adult cases [ 26 , 30 ]. Terry and Waters [ 29 ] and Wu et al [ 25 ] reported both open and arthroscopic cases, with data of the former being fully extractable.…”

Section: Resultsmentioning

confidence: 99%

“…A clear history of a wrist trauma was reported for 163 patients (64.1%). Palmer’s TFCC tear classification was used in six studies [ 23 , 24 , 25 , 27 , 28 , 29 ]. The most common injury types reported were Palmer types 1B ( n = 140, 54.1%) and 1D ( n = 40, 15.4%).…”

Section: Resultsmentioning

confidence: 99%

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Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

Schachinger

Farr

2021

JCM

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Introduction: Injury to the triangular fibrocartilage complex (TFCC) may cause chronic wrist pain and instability if left untreated. The current literature of adult cases suggests that arthroscopic treatment offers favorable outcomes and is associated with a low complication rate. This systematic review evaluated the outcomes of arthroscopic TFCC surgery in adolescents. Materials and Methods: A PRISMA-guided literature search of PubMed, Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Cochrane Clinical Answers was conducted in May 2020. All studies reporting on (1) arthroscopic TFCC repair or debridement in (2) patients under the age of 19 years with (3) a minimum case number of four patients were extracted by two independent observers. The level of evidence of each study was assessed according to the Oxford Centre for Evidence-Based Medicine, and study quality was graded according to the Modified Coleman Methodology Score and the MINORS criteria. Clinical outcome scores, functional parameters, and any complications were reviewed. Results: The selected search terms initially resulted in a total of 986 possible articles. The authors eventually identified eight papers (all LoE IV) for inclusion in this systematic review. A total of 254 patients with verified TFCC tears and a mean age of 16 years (range, 7–19) received arthroscopic repair (162 patients, 67.1% of total) or debridement (77 patients, 29.7% of total). Arthroscopic treatment resulted in low pain levels, high patient satisfaction, and a fast return to sport. Complications overall were sparse and consisted mainly of persistent wrist pain (n = 31) and temporary paresthesia (n = 6) of the dorsal sensory branch of the ulnar nerve. Recurrent tears were sparse, with only four reported cases due to sports participation. Conclusion: Wrist arthroscopy is a reliable surgical option for treating TFCC tears in adolescents. The results obtained are comparable to those published in the literature. However, the variety of repair techniques and the low level of evidence across all included articles demand further prospective studies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

Schachinger

Farr

2021

JCM

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“…Several factors may explain these results. The young age of the athletes involved could have played a critical role, thanks to the greater recovery and healing capacity of ligament and tendons in the younger population (Fishman et al., 2018; Ithurburn et al., 2019), especially when no other comorbidities (such as smoking) are present. Collagen synthesis and collagenolytic activity diminish with increasing age, with a decreased collagen turnover, which ultimately leads to a reduced tensile strength and increased mechanical stiffness (McCarthy and Hannafin, 2014; Vogel, 1980).…”

Section: Discussionmentioning

confidence: 99%

Modified Viegas dorsal capsuloplasty for chronic partial injury of the scapholunate ligament in young athletes: outcomes at 24 months

Rosa

Sapino

Vita

et al. 2020

J Hand Surg Eur Vol

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The treatment of chronic scapholunate ligament tears in patients with high demand, such as young athletes, is difficult as traditional techniques are associated with some loss of wrist motion and grip strength. This retrospective investigation studied young athletes (≤20 years old) with chronic scapholunate ligament lesions and a minimum follow-up of 24 months, treated with a modified Viegas dorsal capsuloplasty. Twenty-six young athletes (mean age 17 years) were included. A partial scapholunate ligament tear (Geissler III) was seen in 25 patients. At the last follow-up, a significantly different improvement was seen in all measured parameters and all patients could return to their original competitive activity, within 6 months (range 4–12) after surgery. Level of evidence: IV

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“…Once thought rarely to occur in pediatric patients, arthroscopy recently showed TFCC tears in 48.5-80.5% of pediatric patients with persistent wrist pain [14][15][16]. Despite the absence of knowledge regarding TFCC features and its normal variation on MRI in children and adolescents, an increasing number of articles on surgical techniques and outcomes for TFCC injury have been published since [17][18][19][20][21]. We are not aware of any studies on TFCC features on MRI in adolescents and hypothesize that TFCC abnormalities are also prevalent in the asymptomatic pediatric population.…”

Section: Introductionmentioning

confidence: 99%

The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

et al. 2021

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Objective The objective of the study is to provide a reference for morphology, homogeneity, and signal intensity of triangular fibrocartilage complex (TFCC) and TFCC-related MRI features in adolescents. Materials and methods Prospectively collected data on asymptomatic participants aged 12–18 years, between June 2015 and November 2017, were retrospectively analyzed. A radiograph was performed in all participants to determine skeletal age and ulnar variance. A 3-T MRI followed to assess TFCC components and TFCC-related features. A standardized scoring form, based on MRI definitions used in literature on adults, was used for individual assessment of all participants by four observers. Results per item were expressed as frequencies (percentages) of observations by all observers for all participants combined (n = 92). Inter-observer agreement was determined by the unweighted Fleiss’ kappa with 95% confidence intervals (95% CI). Results The cohort consisted of 23 asymptomatic adolescents (12 girls and 11 boys). Median age was 13.5 years (range 12.0–17.0). Median ulnar variance was −0.7 mm (range − 2.7–1.4). Median triangular fibrocartilage (TFC) thickness was 1.4 mm (range 0.1–2.9). Diffuse increased TFC signal intensity not reaching the articular surface was observed in 30 (33%) observations and a vertical linear increased signal intensity with TFC discontinuation in 19 (20%) observations. Discontinuation between the volar radioulnar ligament and the TFC in the sagittal plane was seen in 23 (25%) observations. The extensor carpi ulnaris was completely dislocated in 10 (11%) observations, more frequent in supinated wrists (p = 0.031). Inter-observer agreement ranged from poor to fair for scoring items on the individual TFCC components. Conclusion MRI findings, whether normal variation or asymptomatic abnormality, can be observed in TFCC and TFCC-related features of asymptomatic adolescents. The rather low inter-observer agreement underscores the challenges in interpreting these small structures on MRI. This should be taken into consideration when interpreting clinical MRIs and deciding upon arthroscopy.

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Outcomes of Operative Treatment of Triangular Fibrocartilage Tears in Pediatric and Adolescent Athletes

Abstract: Level IV.

Cited by 15 publications

References 20 publications

Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

Arthroscopic Treatment Results of Triangular Fibrocartilage Complex Tears in Adolescents: A Systematic Review

Modified Viegas dorsal capsuloplasty for chronic partial injury of the scapholunate ligament in young athletes: outcomes at 24 months

The triangular fibrocartilage complex on high-resolution 3 T MRI in healthy adolescents: the thin line between asymptomatic findings and pathology

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