There is still controversy regarding the value of arthroscopic suture of triangular fibrocartilage complex (TFCC) peripheral tears compared with open transosseous repair because only the latter method restores foveal insertions of TFCC in case of distal radioulnar joint (DRUJ) instability. Five classes of TFCC peripheral tears are recognized in a treatment-oriented algorithm based on arthroscopic findings, and indications to proper treatment are set accordingly. Complete repairable tears (class 2) and proximal repairable tears (class 3) are associated with DRUJ instability and require foveal reattachment of the TFCC. We describe a new arthroscopic technique to repair the foveal attachment of the TFCC with the use of a suture anchor, which is indicated for class 2 and 3 TFCC peripheral tears, instead of an open repair. This technique requires a dedicated working portal to approach the fovea ulnaris. This Direct Foveal portal is used to prepare the ligament and bone and to drill and insert a suture anchor loaded with a pair of sutures. Under arthroscopic vision, a suture is passed through each limb of the ligament and tied using a small knot-pusher. This arthroscopic technique restores original TFCC anatomy and adequate DRUJ stability with less morbidity and potentially accelerated rehabilitation compared with open repair.

The aim of this study was to assess the objective and subjective functional outcomes after foveal reattachment of proximal or complete ulnar-sided triangular fibrocartilage complex lesions by two surgical procedures: an open technique or an arthroscopically assisted repair. The study was done prospectively on 49 wrists affected by post-traumatic distal radio-ulnar joint instability. Twenty-four patients were treated with the open technique (Group 1) and 25 by the arthroscopically assisted technique (Group 2). Magnetic resonance imaging demonstrated a clear foveal detachment of the triangular fibrocartilage complex in 67% of the cases. Arthroscopy showed a positive ulnar-sided detachment of the triangular fibrocartilage complex (positive hook test) in all cases. Distal radio-ulnar joint stability was obtained in all but five patients at a mean follow-up of 6 months. Both groups had improvement of all parameters with significant differences in wrist pain scores, Mayo wrist score, Disability of the Arm, Shoulder and Hand questionnaire and Patient-Rated Wrist/Hand Evaluation questionnaire scores. There were no significant post-operative differences between the two groups in the outcome parameters except for the Disability of the Arm Shoulder and Hand questionnaire score, which was significantly better in Group 2 (p < 0.001).

No abstract

We treated a prospective series of 18 patients (nine men and nine women) with a mean age of 35 years (range 15 to 57), with chronic predynamic or dynamic scapholunate instability by a dorsal intercarpal ligament capsulodesis using the modified Mayo technique. All the patients were assessed by the modified Mayo wrist score and DASH questionnaire. Wrist arthroscopy was done in all patients before open surgery in order to grade the scapholunate instability and correlate the findings with the radiographic and MRI results. At an average follow-up of 45 months (range 34 to 60) pain significantly diminished (P < 0.05) with improvement in the grip strength (P < 0.005) in all 18 cases. Wrist motion remained almost the same. The mean Mayo wrist score improved from 62 to 84 (P < 0.005).We recommend dorsal capsulodesis by using the dorsal intercarpal ligament flap for the treatment of scapholunate dissociation, when the ligament is still repairable.

An Italian version of the patient-rated wrist/hand evaluation (PRWHE) questionnaire was obtained through the standardized process of cross-cultural adaptation. The PRWHE-Italian (IT) was tested on 63 patients in order to evaluate comprehension, reliability and validity as correlated to the validated version of the disabilities of the arm shoulder and hand (DASH)-IT and SF-36. No patients had difficulty completing the PRWHE-IT questionnaire. Psychometric testing demonstrated high reliability (Cronbach's alpha coefficient = 0.9607) and internal and external validity (Pearson correlation coefficient r = 0.927 with PRWHE, r < 0.810 with DASH and r < -0.476 with SF-36). The Italian version of the PRWHE has equivalent evaluation capacities to the original English version and is a reliable functional outcome measurement instrument for wrist and hand disorders.