Arthroscopic Repair of Triangular Fibrocartilage Complex Tears

Estrella, Emmanuel P.; Hung, L.K.; Ho, Pak‐Cheong; Tse, Wing Lam

doi:10.1016/j.arthro.2007.01.026

Cited by 176 publications

(116 citation statements)

References 25 publications

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“…They do not reconstitute the foveal origin, and instability may persist. Estrella et al 9 reported results of a capsular repair of peripheral TFCC tears with unsatisfactory results in 26%, of which 45% were related to persistent DRUJ instability. Normally, the palmar and dorsal limbs are isometric in length.…”

Section: Historical Perspectivementioning

confidence: 99%

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Anatomic Foveal Reconstruction of the Triangular Fibrocartilage Complex With a Tendon Graft

Bain

McGuire

Lee

et al. 2014

Techniques in Hand &Amp; Upper Extremity Surgery

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An acute injury to the triangular fibrocartilage complex (TFCC) with avulsion of the foveal attachment can produce distal radioulnar joint (DRUJ) instability. The avulsed TFCC is translated distally so the footprint will be bathed in synovial fluid from the DRUJ and will become covered in synovitis. If the TFCC fails to heal to the footprint, then persistent instability can occur. The authors describe a surgical technique indicated for the treatment of persistent instability of the DRUJ due to foveal detachment of the TFCC. The procedure utilizes a loop of palmaris longus tendon graft passed through the ulnar aspect of the TFCC and into an osseous tunnel in the distal ulna to reconstruct the foveal attachment. This technique provides stability of the distal ulna to the radius and carpus. We recommend this procedure for chronic instability of the DRUJ due to TFCC avulsion, but recommend that suture repair remain the treatment of choice for acute instability. An arthroscopic assessment includes the trampoline test, hook test, and reverse hook test. DRUJ ballottement under arthroscopic vision details the direction of instability, the functional tear pattern, and unmasks concealed tears. If the reverse hook test demonstrates a functional instability between the TFCC and the radius, then a foveal reconstruction is contraindicated, and a reconstruction that stabilizes the radial and ulnar aspects of the TFCC is required. The foveal reconstruction technique has the advantage of providing a robust anatomically based reconstruction of the TFCC to the fovea, which stabilizes the DRUJ and the ulnocarpal sag.Key Words: triangular fibrocartilage complex, foveal tear, DRUJ instability, wrist arthroscopy, TFCC repair (Tech Hand Surg 2014;18: 92-97) HISTORICAL PERSPECTIVEThe triangular fibrocartilage complex (TFCC) is a complex 3-dimensional structure made up of the proximal triangular ligament or the radioulnar ligaments (RUL), the distal hammock structure, and the ulnar collateral ligaments. 1,2 The distal hammock structure and the ulnar collateral ligaments are distal components, inserting into the ulnar styloid. The palmar and dorsal portions of the RUL originate from the distal margin of the sigmoid notch and converge to attach to the ulna. As the ligaments extend ulnarly, they divide into a distal component that attaches to the ulnar styloid and a proximal component that attaches to the fovea. [3][4][5][6] The articular disk extends from the ulnar edge of the lunate fossa at the distal rim of the sigmoid notch and blends peripherally with the RUL.The foveal insertion of the TFCC contributes more to DRUJ stability than the styloid insertion because of its closer relationship to the rotational axis of the forearm. 4 In fractures of the ulnar styloid with disruption of the distal components of TFCC, patients may not experience DRUJ instability due to an intact foveal attachment. 7 However, disruption of the TFCC at its foveal attachment can result in DRUJ instability. 3,5 Palmer 8 proposed a classification syst...

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Section: Historical Perspectivementioning

confidence: 99%

“…Class I B tears are traumatic ulnar-sided peripheral tears that are more amendable to repair. 9 Atzei and Luchetti 2 recently subclassified the Palmer 1B tear into a distal component, proximal component, or both (complete) to guide treatment. Anatomic TFCC repair into the fovea is recommended for proximal or complete tears.…”

Section: Historical Perspectivementioning

confidence: 99%

Anatomic Foveal Reconstruction of the Triangular Fibrocartilage Complex With a Tendon Graft

Bain

McGuire

Lee

et al. 2014

Techniques in Hand &Amp; Upper Extremity Surgery

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“…4 Melone and Nathan analyzed peripheral TFCC tears, classifying them into five stages according to ulnar head instability: stage I is a detachment of the articular disc from the base of the ulnar styloid, stage II is a disruption of the infraretinacular ECU subsheath, stage III includes damage to the UC ligaments, stage IV entails either a partial or complete rupture of the lunotriquetral interosseous ligament, and stage V compromises the midcarpal joint because of disruption of the triquetral-capitate and triquetral-hamate ligament. 14 Stage II is similar to, but not the same lesion as, a dorsal tear.…”

Section: Discussionmentioning

confidence: 99%

“…A dorsal tear of the TFCC was first clearly described by Estrella et al in 2007 4 as being located in the area between the extensor carpi ulnaris (ECU) subsheath and the extensor digiti minimi (EDM)-a precarious site for tear. Abe et al reported…”

mentioning

confidence: 99%

Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment

et al. 2016

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The triangular fibrocartilage complex (TFCC) is an important stabilizer of the distal radioulnar joint (DRUJ) and a load absorber of the ulnocarpal (UC) joint. A TFCC injury is also recognized as a major cause of ulnar-sided wrist pain. Palmer has classified traumatic TFCC tears into four subtypes depending on the location of the tear. 1 As more recent studies have clarified the anatomical structure of TFCC 2,3 and through the use of wrist arthroscopy, it has become evident that not all of the TFCC tear patterns are included in Palmer original classification.A dorsal tear of the TFCC was first clearly described by Estrella et al in 2007 4 as being located in the area between the extensor carpi ulnaris (ECU) subsheath and the extensor digiti minimi (EDM)-a precarious site for tear. Abe et al reported AbstractBackground Several different triangular fibrocartilage complex (TFCC) tear patterns have been classified through the use of wrist arthroscopy. A tear of the dorsal aspect of the TFCC has been previously reported, but it is not included in Palmer original classification. Our purpose was to describe this type of tear pattern along with the clinical presentation. Methods An isolated dorsal TFCC tear was encountered in seven wrists of six patients (three men and three women; average age was 31 years). All patients were evaluated by physical exam, X-ray, plain axial computed tomography with pronation, neutral and supination position, magnetic resonance imaging (MRI) with coronal, sagittal, and axial section and arthroscopy. Results The clinical findings varied and included the following: tenderness at the dorsoulnar aspect of the wrist was positive in all wrists, fovea sign was positive in five wrists, and tenderness at the dorsal aspect of the distal radioulnar joint was present in one wrist. Pain with forearm rotation was positive in all wrists. The ulnar head ballottement test induced pain in all wrists, whereas dorsal instability of the ulnar head was present in one wrist with this test. The ulnocarpal stress test was positive in five wrists. Axial and sagittal images on MRI revealed the dorsal tear in five wrists. All wrists were treated with an arthroscopic capsular repair. The final functional outcome at an average follow-up of 16.1 months was four excellent and one good wrist according to the modified Mayo wrist score. Conclusions The aim of this article is to describe our experiences with tears involving the dorsal aspect of the TFCC, which may be misdiagnosed if the surgeon is not cognizant of this injury. Type of study/level of evidence Diagnostic/level IV

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“…Her ne kadar açık yöntemlerde [16][17][18] olduğu kadar artroskopik yöntem-lerde de [10,[19][20][21][22][23][24] iyi sonuçlar bildirilmesine rağmen artroskopik yöntemlerle açık yöntemlere göre eklem hareket açıklığı ile yakalama kuvvetinin artmasının [22] yanı sıra ulnar sinire bağlı oluşan komplikasyonlarında azaldığı bildirilmektedir. [18,19,21] Ayrıca artroskopi ile yapılan ameliyat sırasında TFKK yırtıklarına eşlik eden diğer eklem içi patolojilerin değerlendirilmesi yapı-labilmektedir.…”

Section: Discussionunclassified

Results of arthroscopic repair of triangular fibrocartilage complex peripheral tears (Palmer type 1B)

Kabakas¹,

Özçelık²,

Uğurlar³

et al. 2014

Ulus Travma Acil Cerrahi Derg

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SONUÇ:Artroskopik teknikle minimal hasarlanma ile TFKK tamiri yapılabilmekte, eklemin tüm yapılarının daha iyi görüntülenmesi ve değerlendirilmesi sağlanabilmektedir. 6R portalin 1 cm altından açılan portalden uygulanan dışarıdan içeriye dikiş tekniği ulnar sinir yüzeyel dalının etkilenme olasılığının olmadığı minimal travmatik yöntemdir. Bu yöntem ile ameliyat öncesi ağrı şikayetlerinin anlamlı olarak giderilmesi mümkündür.Anahtar sözcükler: Artroskopi; el bileği eklemi; el bileği yaralanmaları; triangular fibrokartilaj kompleks.

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Arthroscopic Repair of Triangular Fibrocartilage Complex Tears

Cited by 176 publications

References 25 publications

Anatomic Foveal Reconstruction of the Triangular Fibrocartilage Complex With a Tendon Graft

Anatomic Foveal Reconstruction of the Triangular Fibrocartilage Complex With a Tendon Graft

Dorsal Tear of Triangular Fibrocartilage Complex: Clinical Features and Treatment

Results of arthroscopic repair of triangular fibrocartilage complex peripheral tears (Palmer type 1B)

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