Pathomorphologic Findings of Wrist Arthroscopy in Children and Adolescents With Chronic Wrist Pain

Farr, Sebastian; Grill, Franz; Rudolf, G.; Gráf, Alexandra; Girsch, Werner

doi:10.1016/j.arthro.2012.04.152

Cited by 29 publications

(31 citation statements)

References 27 publications

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“…However, recent studies reported different findings. Thus, isolated TFCC tears with concomitant DRUJ instability must be taken into consideration in patients with ulnarsided wrist pain [4,30]. Early treatment may be important in symptomatic patients with traumatic tears with pain duration being essential for achieving satisfactory results [31].…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

Schachinger

Wiener²,

Carvalho³

et al. 2020

Arch Orthop Trauma Surg

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Introduction Recent reports in the adult literature reported the use of standardized radiographic measurement techniques to determine distal radioulnar joint (DRUJ) instability. The aim of this study was to evaluate the efficacy and accuracy of (1) the MRI-based modified radioulnar ratio technique and (2) the pisoscaphoid (PiSca) and radioulnar (RaUl) distances in true lateral radiographs in children and adolescents with arthroscopically-verified TFCC tears. Materials and methods We retrospectively assessed lateral wrist radiographs and axial MRI sequences of 18 adolescent patients (22 wrists) who had arthroscopically-confirmed TFCC tears and compared them to similar imaging of a control group of 28 healthy patients (28 wrists). Three raters assessed the images twice in a 2-week interval. Intraclass correlation coefficients (ICCs), unifactorial ANOVA, and ROC analysis were performed with regards to the different radiographic variables. Results The interrater ICCs were almost perfect for all measurements except RaUl1, which showed a substantial agreement (0.751) among the three observers. The intrarater ICCs were almost perfect when measuring PiSca and MRI, and substantial to almost perfect for RaUl. Pearson's correlation showed a moderate, positive correlation between PiSca and RaUl distances (r = 0.608; p < 0.001), and a moderate, negative correlation between RaUl distance and MRI shift (r = − 0.486; p = 0.010). When the three core groups (peripheral, central tear, controls) were compared to each other regarding the radiographic instability parameters, only the MRI shift revealed a statistically significant difference (p = 0.003). Comparisons revealed significant differences between patients and controls (p = 0.004) and peripheral tears vs. controls (p = 0.001 and p = 0.010). The ROC analysis revealed a significant AUC only for the MRI (AuC 0.787 and p = 0.002). Conclusions Children and adolescents with peripheral TFCC tears showed significantly increased instability parameters in MRI compared to controls. These measurement techniques are no replacement for a thorough clinical examination but may be helpful for indicating diagnostic wrist arthroscopy in ambiguous cases. Level of evidence Level III; Diagnostic.

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Section: Discussionmentioning

confidence: 99%

“…Thus, as mentioned above, this technique can be used preoperatively to determine potential TFCC tears in children and adolescents and may provide help for surgical indication setting in doubtful cases. In such cases, diagnostic wrist arthroscopy is still considered the diagnostic gold standard [19,30].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

Schachinger

Wiener²,

Carvalho³

et al. 2020

Arch Orthop Trauma Surg

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“…Magnetic resonance imaging (MRI) studies were obtained for all patients prior to surgery. We adhered to a previously published treatment algorithm for children and adolescents with chronic wrist pain [8]. Important pre-operative clinical parameters such as wrist and forearm range-of-motion, intraoperative findings (including type of TFCC tear according to Palmer et al [9]), concomitant surgical procedures, preoperative pain level (visual analogue scale [VAS], 0-10 point scale) and the Modified Mayo Wrist Score (MMWS; 91-100 points, excellent; 81-90 points, good; 71-80 points, fair; ≤70 points, poor; [10,11]) were determined by retrospective chart review.…”

Section: Patients and Outcome Measuresmentioning

confidence: 99%

Clinical experience with arthroscopically-assisted repair of peripheral triangular fibrocartilage complex tears in adolescents—technique and results

Farr

Zechmann

Rudolf

et al. 2015

International Orthopaedics (SICOT)

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“…We followed a previously established treatment algorithm for children and adolescents with chronic wrist pain. 2 Since 3 months of conservative treatment may be brief for some patients, we usually follow conservative treatment for up to 6 months if imaging is unremarkable. Certain preoperative clinical findings including wrist and forearm range-of-motion (ROM), intraoperative findings (including the type of TFCC tear according to Palmer 20 ), concomitant surgical procedures, preoperative wrist pain level according to a visual analog scale (VAS; 0-10 point scale), and the MMWS (91-100 points, excellent; 81-90 points, good; 71-80 points, fair; 70 points, poor) 21,22 were determined by a formal chart review.…”

Section: Follow-up and Outcome Measuresmentioning

confidence: 99%

“…To date, only a few reports in the literature mentioned arthroscopic wrist surgery in children, and even fewer studies investigated results after TFCC surgery in this age group. 2,[17][18][19] Farr et al, for example, reported good short-term clinical outcomes after TFCC repair. They showed significant pain reduction and improvement in both Modified Mayo Wrist Scores (MMWS) and physiologic grip strength when compared with the contralateral side in 12 adolescents.…”

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Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents

et al. 2017

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To the best of our knowledge, we are not aware of any reports focusing on results of arthroscopic debridement of triangular fibrocartilage complex (TFCC) tears in immature patients. The purpose of this study was to evaluate our results after arthroscopic debridement of TFCC tears in adolescents. We retrospectively identified all patients of 18 years or less, who received an arthroscopic TFCC debridement due to a traumatic or degenerative tear according to Palmer. These cases were clinically re-evaluated after a mean period of 6.7 years (SD ± 3.9 years). All patients completed the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder and Hand (DASH) inventory, and Patient-Rated Wrist Evaluation (PRWE). Thirteen adolescent patients (mean age: 15.6 ± 2.2 years at surgery) were included. The mean MMWS increased significantly from 70 ± 13.6 to 90 ± 6.5 after the TFCC debridement; mean postoperative DASH and PRWE scores of 17 ± 15.2 and 21 ± 18.5, respectively, indicated good and excellent outcomes for the majority of the cohort. The mean pain level decreased significantly from a mean of 5.7 ± 2.0 to 1.8 ± 2.0 at follow-up. Six patients needed a reoperation to achieve a successful outcome. Arthroscopic debridement of TFCC tears, performed as a concomitant wrist surgery in adolescents, efficiently reduced wrist pain and yielded good to excellent results in the long term. However, under certain circumstances, its results are unpredictable and further surgery may be necessary to eventually achieve the satisfying outcomes. Further studies are needed to confirm these findings. Level IV, therapeutic case series.

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Pathomorphologic Findings of Wrist Arthroscopy in Children and Adolescents With Chronic Wrist Pain

Cited by 29 publications

References 27 publications

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

Evaluation of radiological instability signs in the distal radioulnar joint in children and adolescents with arthroscopically-verified TFCC tears

Clinical experience with arthroscopically-assisted repair of peripheral triangular fibrocartilage complex tears in adolescents—technique and results

Outcomes after Arthroscopic Debridement of the Triangular Fibrocartilage Complex in Adolescents

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