Arthroscopically Assisted Repair of Triangular Fibrocartilage Complex Foveal Tears

Shinohara, Takaaki; Tatebe, Masahiro; Okui, Nobuyuki; Yamamoto, Masayuki; Kurimoto, Shigeru; Hirata, Hitoshi

doi:10.1016/j.jhsa.2012.11.008

Cited by 87 publications

(102 citation statements)

References 21 publications

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“…Although the capsulorrhaphy-type repair techniques may be adequate for dorsal TFCC tears without DRUJ instability, foveal reattachment and healing may not be guaranteed using such techniques if the TFCC is detached from its foveal insertion. 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%

“…Nakamura et al 3 and Shinohara et al 4 reported their arthroscopically assisted transosseous outside-in techniques to reattach the TFCC using 2 separate 1.2-mm osseous tunnels from the ulnar neck to the ulnar fovea region. However, creating these 2 separate tunnels in such a small ulnar fovea region is technically demanding with little room for error.…”

Section: Discussionmentioning

confidence: 99%

“…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][2][3][4][5] or using a suture anchor. [6][7][8][9][10] However, these techniques require 1 relatively large or 2 separate tunnels in the small ulnar head or a costly suture anchor.…”

mentioning

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%

mentioning

confidence: 99%

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Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Chen

2017

Arthroscopy Techniques

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“…4,21,22 A longitudinal skin incision approximately 1.5 cm long was made at the ulnar side of the ulnar neck, and the ulna between the ECU and the FCU was exposed. Two osseous tunnels were made by inserting two parallel 1.2 mm K-wires from the ulnar neck to the foveal region under DRUJ arthroscopy.…”

Section: Methodsmentioning

confidence: 99%

Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain

Nishizuka

Tatebe

Hirata

et al. 2013

The Bone & Joint Journal

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The purpose of this study was to evaluate treatment results following arthroscopic triangular fibrocartilage complex (TFCC) debridement for recalcitrant ulnar wrist pain. According to the treatment algorithm, 66 patients (36 men and 30 women with a mean age of 38.1 years (15 to 67)) with recalcitrant ulnar wrist pain were allocated to undergo ulnar shortening osteotomy (USO; n = 24), arthroscopic TFCC repair (n = 15), arthroscopic TFCC debridement (n = 14) or prolonged conservative treatment (n = 13). The mean follow-up was 36.0 months (15 to 54). Significant differences in Hand20 score at 18 months were evident between the USO group and TFCC debridement group (p = 0.003), and between the TFCC repair group and TFCC debridement group (p = 0.029). Within-group comparisons showed that Hand20 score at five months or later and pain score at two months or later were significantly decreased in the USO/TFCC repair groups. In contrast, scores in the TFCC debridement/conservative groups did not decrease significantly. Grip strength at 18 months was significantly improved in the USO/TFCC repair groups, but not in the TFCC debridement/conservative groups. TFCC debridement shows little benefit on the clinical course of recalcitrant ulnar wrist pain even after excluding patients with ulnocarpal abutment or TFCC detachment from the fovea from the indications for arthroscopic TFCC debridement.

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“…6,24–26 Atzai reported results for the use of suture anchors for reattachment. In this study, the mean pain score improved from 8.3 to 1.2, and the Modified Mayo Wrist Score was excellent or good in 94% of all patients.…”

Section: Repair Of the Ulnar Side (Palmer 1b)mentioning

confidence: 99%

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair

2017

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SYNOPSIS This review shows trends in triangular fibrocartilage complex (TFCC) repair since 1990 by geographic area and year. The repair methods presented in the literature were inside-out, outside-in, all-inside, and open repair. The outside-in technique was reported most often for ulnar-side tears whereas the inside-out technique was reported most frequently for radial-side tears. Recently, a foveal reattachment technique for ulnar-side tears has garnered attention and has been reported with increasing frequency, especially in Asia, because the deepest portion of TFCC, attached to fovea, plays a key role in stabilizing the distal radioulnar joint (DRUJ). Understanding these trends can help us to best treat TFCC tears.

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Arthroscopically Assisted Repair of Triangular Fibrocartilage Complex Foveal Tears

Cited by 87 publications

References 21 publications

Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Arthroscopically Assisted Transosseous Foveal Repair of Triangular Fibrocartilage Complex

Simple debridement has little useful value on the clinical course of recalcitrant ulnar wrist pain

Chronologic and Geographic Trends of Triangular Fibrocartilage Complex Repair

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