Arthroscopically Assisted Reconstruction of Triangular Fibrocartilage Complex Foveal Avulsion in the Ulnar Variance-Positive Patient

Kim, Byung‐Sung; Yoon, Hongkee; Nho, Jae‐Hwi; Park, Kang Hee; Park, Sung-Yong; Yoon, Jennifer R.; Song, Hyun Seok

doi:10.1016/j.arthro.2013.08.022

Cited by 39 publications

(44 citation statements)

References 27 publications

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“…Other techniques using a suture anchor to reattach the TFCC to the fovea are also reported with good results. [6][7][8][9][10] However, inserting the suture anchor into the fovea provides only a point contact for the TFCC foveal reattachment and occupies the bony surface of the TFCC footprint on which the TFCC should heal. In our technique, only one 1.6-mm osseous tunnel is created, but it allows 4 suture limbs to pass and reattach the TFCC back to the fovea.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, some arthroscopic techniques to reattach a fovealavulsed TFCC have been reported as using the transosseous tunnel [1][2][3][4][5] or the suture anchor. [6][7][8][9][10] Iwasaki and Minami reported an arthroscopic technique of reattachment of the avulsed TFCC to the ulnar fovea by creating a 2.9-mm osseous tunnel from the ulnar neck to the fovea to pass the sutures.…”

Section: Discussionmentioning

confidence: 99%

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Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Chen

2017

Arthroscopy Techniques

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The radioulnar ligament of the triangular fibrocartilage complex (TFCC), especially the deep fibers inserted at the ulnar fovea, is the key component for the distal radioulnar joint (DRUJ) stability. Traumatic injuries to the TFCC foveal insertion would cause DRUJ instability. Traditionally, arthroscopic techniques of the TFCC repair are suturing the ulnarsided disruption peripherally to the dorsal or ulnar capsule instead of suturing the TFCC to the fovea and thus fail to restore the DRUJ stability if the TFCC is detached from the fovea. Recently, some arthroscopic foveal repair techniques have been reported using a suture anchor or transosseous sutures to address the foveal tear. This technical note describes an arthroscopic transosseous technique to reattach the foveal-disrupted TFCC. A 1.6-mm small osseous tunnel is created on the radial border of the fovea and 4 sutures are passed into the tunnel by using a 16-gauge needle. The TFCC could be sutured arthroscopically with these 4 sutures and be compressed against the fovea. Our technique provides not only a good suture construct for TFCC foveal reattachment but also an anatomic contact surface between the torn TFCC and its foveal footprint for healing. We recommend this technique as an alternative for repairing TFCC foveal tear.T he radioulnar ligament of the triangular fibrocartilage complex (TFCC), especially the deep fibers inserted at the ulnar fovea, is the key component for the distal radioulnar joint (DRUJ) stability. Traumatic injuries to the TFCC foveal insertion would cause DRUJ instability. The aim of treatment for this foveal disruption is to reattach the disrupted radioulnar ligament to its foveal insertion. Recently, some arthroscopic techniques to reattach a torn TFCC to its foveal insertion have been reported using the transosseous tunnel 1-5 or using a suture anchor. 6-10 However, these techniques require 1 relatively large or 2 separate tunnels in the small ulnar head or a costly suture anchor. Thus, we present our arthroscopic transosseous TFCC repair technique to reattach the foveal-avulsed TFCC to its foveal footprint anatomically. Clinical Assessment of TFCC InjuryA clinical suspicion of TFCC foveal tear is based on the traumatic history of the involved wrist, positive ulnar fovea sign, and DRUJ laxity found in the DRUJ ballottement test. Routine radiograph examination is used to evaluate the ulnar variance, arthritis status of the ulnocarpal joint and DRUJ, and the possibly associated ulnar styloid fracture or nonunion. This clinical suspicion of TFCC foveal tear could also be illustrated by magnetic resonance imaging. Indications for SurgeryInitial conservative treatment with 4-week cast immobilization of forearm rotation and wrist range of motion is given for TFCC injuries that exhibit fair DRUJ stability. Surgery is indicated for TFCC injuries with failed conservative treatment or TFCC injuries with gross DRUJ instability that is supported by the magnetic resonance imaging evidence of TFCC foveal disruption. Poor TFCC tiss...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Chen

2017

Arthroscopy Techniques

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“…Miwa et al proceeded to surgery after 2 months with persistent "unendurable pain." 9 Tang et al, 10 Kim et al, 11 Sarkissian et al, 12 and Iwasaki et al 13 all moved to surgery after 3 months with Iwasaki et al using a removal wrist brace for immobilization. Ruch and Papadonikolakis 14 and Infanger and Grimm 15 proceeded after at least 4 months of conservative management and Papapetropoulos et al, 16 Bayoumy et al, 17 and Millants et al 18 utilized 6 months of conservative management with splinting and anti-inflammatories prior to surgical intervention.…”

Section: Nonoperative Treatmentmentioning

confidence: 99%

A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment

McNamara

Colakoğlu

Iorio

2020

Journal of Hand and Microsurgery

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Triangular fibrocartilage complex (TFCC) injuries can present incidentally as an asymptomatic lesion or can cause acute and chronic pain. This study compared different treatment approaches for symptomatic Palmer Type 1 TFCC injuries and rates of improvement using a systematic review of the literature. Two hundred thirty-one articles were identified, 43 met criteria and were included. Two of these articles indicated conservative therapy may be adequate. Patients who underwent debridement for any Type 1 Palmer class returned to work at a rate of 92% (n = 182), but only 44% (n = 38) were free of pain. For 1B lesions that underwent repair, 68.3% (n = 226) were able to return to work and 41% (n = 52) had persistent pain. 1D lesions were treated with both repair and debridement with similar results. Data for Types 1A and 1C were limited as no authors solely addressed these lesions. For 1A lesions, those treated with traditional treatment of debridement still had high rates of being unable to return to work. The literature remains insufficient, making comparison between studies and techniques difficult. For asymptomatic injuries, there is no need for treatment. For patients with recalcitrant symptoms, surgery improves pain, grip strength, and increases return to work and activity. The level of evidence is IV.

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“…Das Knoten der Naht erfolgt in Neutralstellung des Unterarms. Kontraindikationen sind die Arthrose im DRUG und eine statische Ulna-plus-Varianz [48]. Im OP wird eine Oberarmgipsschiene in Neutralstellung angelegt.…”

Section: Tiefes Blatt (Atzei 3)unclassified

Instability of the distal radioulnar joint

Spies¹,

Prommersberger

Langer

et al. 2015

Unfallchirurg

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Injuries of the triangular fibrocartilage complex (TFCC) may be fatal to the distal radioulnar joint (DRUJ). This structure is one of the crucial stabilizers and guarantees unrestricted pronosupination of the forearm. A systematic examination is mandatory to diagnose DRUJ instability reliably. A clinical examination in comparison to the contralateral side is obligatory. Plain radiographs are required to exclude osseous lesions or deformities. Computed tomography of both wrists in neutral, pronation and supination is necessary to verify DRUJ instability in ambiguous situations. Based on a systematic examination wrist and DRUJ arthroscopy identify lesions clearly. Injuries of the radioulnar ligaments which entail DRUJ instability, should be reconstructed preferably anatomically. Ulnar-sided TFCC lesions may often cause DRUJ instability. Osseous ligament avulsions are mostly treated osteosynthetically. Ligament tears may be refixated using anchor or transosseous sutures. Tendon transplants are necessary for an anatomical reconstruction in cases of irreparable ruptures.

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Arthroscopically Assisted Reconstruction of Triangular Fibrocartilage Complex Foveal Avulsion in the Ulnar Variance-Positive Patient

Cited by 39 publications

References 27 publications

Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

A Systematic Review and Analysis of Palmer Type I Triangular Fibrocartilage Complex Injuries: Outcomes of Treatment

Instability of the distal radioulnar joint

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