Revisional triangular fibrocartilage complex (TFCC) repair using arthroscopic one-tunnel transosseous suture: preliminary results

Kwon, Young Woo; Park, Ji Hun; Choi, In Cheul; Lee, Joon Suk; Park, Jong Woong

doi:10.1007/s00402-020-03613-1

Cited by 10 publications

(4 citation statements)

References 20 publications

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“…Nevertheless, he also had been able to repair TFCC injuries up to 2 years after trauma, provided the remaining tissue is of good quality [20]. In Kwon′s study [21], 8 patients who underwent revisional arthroscopic TFCC foveal repairs using a one-tunnel transosseous suture technique had signi cant improvement in pain, grip strength, active wrist ROM, MMWS (Modi ed Mayo Wrist Score) and DASH. All of them took more than 6 months from injury to revisional operation (range 10 to 36).…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic delayed repair of residual triangular fibrocartilage complex (TFCC) peripheral tears from distal radial fractures

Zheng,

Zhao,

et al. 2024

Preprint

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Objective Residual triangular fibrocartilage complex (TFCC) peripheral tears is one of causes of chronic persistent ulnar wrist pain following distal radius fractures. The purpose of this study was to evaluate the application of diagnostic wrist arthroscopy in this condition and to access the clinical outcomes of arthroscopic delayed repair of residual TFCC peripheral tears from distal radial fractures. Methods Eight patients who underwent arthroscopic delayed repair of residual TFCC peripheral tears from distal radial fractures were retrospectively analyzed. The torn TFCC of all patients was repaired with arthroscopic trans-osseous or trans-capsular outside-in technique. Postoperative outcomes were evaluated using wrist range of motion (ROM), grip, Visual Analog Scale (VAS) score for pain in activity, Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and surgery-related complications. Results The mean duration from injury to TFCC repair was 11.6 months. The mean follow-up was 25.5 months. At arthroscopy, TFCC dorsal capsule attachment tear was found in 3 patients, Atzei class 1 disruption in 2 patients and Atzei class 2 avulsion in 3 patients. TFCC Palmer 1D injury was found in Atzei 1 class tear case and Atzei 2 class tear case. At the final follow-up, all outcomes were significantly improved except the radial and ulnar deviation. All patients had negative ballottement test and no surgery-related complications were found. Conclusion Arthroscopic delayed repair of residual TFCC peripheral tears from distal radial fractures is effective for those shown no evidence of degeneration and ulnar impaction arthroscopically and their preoperative time less than 16 months.

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Section: Discussionmentioning

confidence: 99%

Arthroscopic delayed repair of residual triangular fibrocartilage complex (TFCC) peripheral tears from distal radial fractures

Zheng,

Zhao,

et al. 2024

Preprint

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“…A signi cant increase in wrist ROM was found after our technique. The main cause of limited wrist ROM is considered to be wrist pain due to DRUJ instability [22] .Anchor nails to repair TFCC injuries provide stability of the DRUJ and reduce wrist pain. Also, a stable DRUJ is an important factor in regaining grip strength after injury [23] , our ndings of a 32.14% gain in mean grip strength after surgery.…”

Section: Discussionmentioning

confidence: 99%

Dorsoulnar injury of the TFCC: clinical features, diagnosis, and treatment

Wang

Raza

Lin

et al. 2023

Preprint

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Introduction TFCC lesions are commonly categorized according to the classification system proposed by Andrew K. Palmer in 1989, which received a lot of attention in recent years due to the development of wrist arthroscopy. However, various investigations highlighted other types of lesions that are not listed in this system. This article aims to describe the clinical features, diagnosis, and treatment of the dorsoulnar TFCC injury, a new type of TFCC lesion that is not included in the Palmer’s classification. Patients And Methods We investigated 68 patients with dorsoulnar TFCC injuries treated with wrist arthroscopy-assisted suture anchor repair. A retrospective review of all cases was performed to assess the clinical manifestations, physical examination, magnetic resonance imaging, and intraoperative findings. In addition, patients were evaluated at greater than 1 year with a range of motion, grip strength, standard outcome measures.Before and after surgery, we measured subjective results using the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. The functional outcome was calculated by the Mayo Wrist Score.And a survey assessing return to work and sports. Results All patients complained of dorsoulnar side wrist pain before surgery. Most of them got a history of trauma, which was not very drastic. The mean age of the patients (30 male and 38 female) at the time of surgery was 39.72 ± 12.6 years. No major complications occurred during surgery and follow-up. Pain perception (VAS: preoperatively 2.96 ± 1.01 vs. Postoperatively 0.09 ± 0.29, p < 0.05) improved significantly. The result of grip strength (preoperatively 25.92 ± 7.18 vs. postoperatively 34.25 ± 10.43, p < 0.05) was satisfactory after surgery. The percentage of grip strength on the affected side compared with that on the healthy side was 0.79 ± 0.10. The DASH score improved significantly (preoperatively 47.98 ± 10.31 vs. Postoperatively 6.35 ± 4.53, p < 0.05). The mean Mayo Wrist Score was 89.41 ± 8.26 at follow-up. Overall, the wrist functions of 59 (86.76%) (excellent: 31, Good: 28) of the patients were satisfactory according to their modified Mayo wrist scores. There was 1 Suture anchor loosening that required repeat surgery. There were no cases of distal radioulnar joint instability at the final follow-up. Conclusions Dorsoulnar damage of the TFCC is not so rare in clinical settings. The combination of clinical manifestations and preoperative physical examination maneuvers, preoperative MR images, and arthroscopic observation provide a definite diagnosis of this type of TFCC injury. We name this new pattern of injury as Palmer 1E lesion. Furthermore, the repair of this type of TFCC tears using suture anchors assisted by wrist arthroscopies is safe and simple with good results.

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“…The single large ulnar tunnel presents as another feature of the present technique and may have several advantages. The bleeding from the cancellous bone may improve tissue healing (Iwasaki et al, 2011;Kwon et al, 2020). In addition, one large tunnel may be easier to create and manage compared with tunnels both in the ulna and radius (Adams and Berger, 2002;Atzei, 2009).…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic one-tunnel transosseous reconstruction of chronic triangular fibrocartilage complex foveal tears: outcomes in 12 patients

Hou

Wang

et al. 2021

J Hand Surg Eur Vol

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We report the surgical method and outcomes of a simple arthroscopic-assisted technique of repairing triangular fibrocartilage complex (TFCC) foveal injuries in 12 patients with chronic distal radioulnar joint instability. An ulnar transosseous tunnel was created with its distal exit point located 3 to 4 mm radial to the fovea. A tendon graft was cut into two parts, and both were then passed through the bone tunnel to secure the radioulnar ligament remnants back to the fovea in a ‘V’ shape configuration. At the final follow-up of 13 to 26 months (average 21), all patients had a reduction of wrist pain, with the mean visual analogue scale dropped from 4.6 to 1.6 out of 10. The distal radioulnar joint was completely stable in nine patients and had improved stability in three patients. The mean Mayo modified wrist scores improved from 72 to 89, and the clinical outcomes were excellent in four patients, good in seven and fair in one. No major surgical complications occurred. This simple arthroscopic one-tunnel transosseous approach is effective for chronic foveal tears of the TFCC with intact radioulnar ligament remnants. Level of evidence: IV

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Revisional triangular fibrocartilage complex (TFCC) repair using arthroscopic one-tunnel transosseous suture: preliminary results

Cited by 10 publications

References 20 publications

Arthroscopic delayed repair of residual triangular fibrocartilage complex (TFCC) peripheral tears from distal radial fractures

Arthroscopic delayed repair of residual triangular fibrocartilage complex (TFCC) peripheral tears from distal radial fractures

Dorsoulnar injury of the TFCC: clinical features, diagnosis, and treatment

Arthroscopic one-tunnel transosseous reconstruction of chronic triangular fibrocartilage complex foveal tears: outcomes in 12 patients

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