Arthroscopic ligament-specific repair for triangular fibrocartilage complex foveal avulsions: a minimum 2-year follow-up study

Abstract

This study reports the arthroscopic ligament-specific repair of the triangular fibrocartilage complex (TFCC) that anatomically restores both the volar and dorsal radioulnar ligaments into their individual foveal footprints. Twenty-five patients underwent arthroscopic ligament-specific repair with clinical and radiological diagnoses of TFCC foveal avulsions. The mean age was 28 years (range 14–47) and the mean follow-up was 31 months (range 24–47). Following arthroscopic assessment, 20 patients underwent double limb radioulnar ligament repairs and five had single limb repairs. At final follow-up, there were significant improvements in wrist flexion–extension, forearm pronation–supination and grip strength. There were also significant improvements in pain and patient-reported outcomes as assessed by the patient-rated wrist evaluation, Disabilities of the Arm, Shoulder and Hand score and modified Mayo wrist scores. Arthroscopic ligament-specific repair of the TFCC does not require specialist dedicated equipment or consumables and offers a viable method of treating these injuries. Level of evidence: IV

Arthroscopic transosseous foveal footprint repair of the triangular fibrocartilage complex

“…The results of our foveal footprint repair are promising and are comparable with other studies of arthroscopic transosseous foveal repair studies (Table 2) (Abe et al., 2018; Iwasaki et al, 2011; Jegal et al., 2016; Liu et al., 2021; Park et al., 2018; Shinohara et al., 2013). The modified Mayo wrist score of 95 with excellent or good results and postoperative DRUJ stability in all were better than with other methods.…”

Advances in the Repair of Palmer type IB TFCC Injuries With Wrist Arthroscopy

“…The PRWE, DASH, and modified Mayo wrist scores were significantly improved compared with those before surgery. However, this study was a retrospective study with a small sample size, and further comparative studies are required to verify the clinical advantages of this theory 48 …”

“…44 Clinically, we observed in the DRUJ approach that the insertion of the RUL was not condensed at 1 point, but instead, there was an extensive insertion area covering the ulnar styloid base from the volar to the ulnar side, which is consistent with anatomic studies, 46 and thus there may be more than 1 RUL rotation point on the dorsal and volar aspects of the TFCC. Liu et al 47,48 presented arthroscopic ligament-specific repair for TFCC using a dual-bone tunnel combined with an ulnar foveal soft-tissue tunnel based on the aforementioned concept (Fig. 9).…”

“…However, this study was a retrospective study with a small sample size, and further comparative studies are required to verify the clinical advantages of this theory. 48 After years of development and promotion, the technique of TFCC repair with 1 tunnel and 2 tunnels has reached a relatively mature state. However, few studies have focused on the biomechanical characteristics and clinical efficacy of the 2 treatment methods.…”

Postoperative Imaging of Ulnar Wrist Pain

“…3). [22][23][24][25] Open and arthroscopic repairs show similar results, although arthroscopically assisted ligament reconstruction minimizes surgical trauma, allowing greater precision in anatomical reconstruction, and with lower rate of complications, especially concerning injuries to the dorsal sensory branch of the ulnar nerve. 26 Class 5 Atzei lesions include chronic unstable lesions of the ulnar insertion of the TFCC, with secondary degeneration of the DRUJ cartilage.…”