Arthroscopic Transosseous Repair for both Proximal and Distal Components of Peripheral Triangular Fibrocartilage Complex Tear

Abstract

Background:Tears of the triangular fibrocartilage complex (TFCC) can result in instability of the distal radioulnar joint (DRUJ) and ulnar-sided wrist pain. This study evaluates clinical results of arthroscopic transosseous repair for both proximal and distal components of TFCC tear with DRUJ instability.Materials and Methods:Ten patients who underwent both proximal component and distal component of TFCC repair were retrospectively reviewed. The proximal component of TFCC was repaired through arthroscopic one-tunnel transosseous suture technique, and the combined distal component tear was repaired to the ulnar capsule using same transosseous tunnel in all cases. Visual analog scale (VAS) score for pain, wrist range of motion, grip strength, and postoperative complications were evaluated after a mean followup period of 23.5 months, and each patient was rated according to modified Mayo wrist score and quick disabilities of the arm, shoulder, and hand (DASH) questionnaire.Results:On arthroscopic findings, the hook test confirmed the proximal component of the TFCC tear and visible capsular detachment from TFCC confirmed combined distal component tear in all patients. At final followup, 7 patients had normal stability of DRUJ and 3 patients showed mild laxity compared with the contralateral side. The mean VAS for pain perception decreased from 4.1 to 0.7, and grip strength was increased significantly. The modified Mayo wrist score and Quick DASH score showed significant functional improvement. No surgery-related complications occurred.Conclusions:Arthroscopic one-tunnel transosseous TFCC foveal repair and simulatneous transosseous capsular repair of distal component can be a safe and effective strategy for repair of complete TFCC tear combined with DRUJ instability.

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

“…Radial and ulnar deviation, unsurprisingly, did not change following ALSR as the proximal components of TFCC are not involved in this axis of wrist motion (Nakamura et al., 2018). Our findings are consistent with the previously reported outcomes for arthroscopic TFCC repair, which showed that patient-reported outcomes, pain, grip strength and range of pronation–supination all invariably improve following surgery (Atzei et al., 2015; Jegal et al., 2016; Park and Park, 2018; Shinohara et al., 2013). Interestingly, while all of our patients had a negative ballottement test postoperatively, not all patients have had successful restoration of stability in the series published using isometric point techniques.…”

“…There are limitations to this study. It is of retrospective design with a relatively small number of participants, although comparable with the existing literature (Atzei et al., 2015; Jegal et al., 2016; Nakamura et al., 2011; Park and Park, 2018; Shinohara et al., 2013). It is a single series study, without comparison with other methods of foveal repair.…”

“…Arthroscopic surgery has the advantage of improved diagnostic accuracy and reduced soft tissue trauma compared with open procedures. A number of arthroscopic TFCC foveal repair techniques are described, but there is large variation in the repair configuration, technical complexity and cost of specialist equipment (Atzei et al., 2015; Chen, 2017; Fujio, 2017; Geissler, 2011; Iwasaki and Minami, 2009; Jegal et al., 2016; Nakamura et al., 2011; Park and Park, 2018; Shinohara et al., 2013). In this study we report on midterm outcomes of our previously reported technique of arthroscopic ligament-specific repair (ALSR) of the TFCC (Liu and Arianni, 2020).…”

Postoperative immobilization using a short-arm cast in the semisupination position is appropriate after arthroscopic triangular fibrocartilage complex foveal repair

“…Similar to non-surgical treatment, previous authors have recommended that the forearm should also be immobilized with a LAC in supination following TFCC foveal repair. 7,8,15 However, others have reported favourable outcomes when the forearm was immobilized with a LAC in the neutral position after this procedure. As with differences in the position of the forearm with a LAC, the recommended duration of immobilization in a cast also varies from four to six weeks.…”

“…arthroscopic surgery, several authors have reported favourable outcomes of arthroscopy-assisted repair in the treatment of foveal tear. [6][7][8][9][10][11] Rotation of the forearm is not a purely rotational movement but includes sliding as the curvature of the sigmoid notch of the radius is twice as large as that of the ulnar head. 2,12 The DRUJ is thus inherently unstable.…”